Abstract
Background
Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome.
Methods
From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses.
Results
Median follow-up was 24 months (range 3–152 months). The 3- and 5-year survival for patients with concomitant EHD were 47% and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95% recurred.
Conclusion
Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.
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References
Ekberg HH, Tranberg KKG, Andersson RR, Lundstedt CC, Hägerstrand II, Ranstam JJ, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986;73(9):727–31.
Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984;119(6):647–51.
Hughes KS, Simon R, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986;100(2):278–84.
Blumgart LLH, Fong YY. Surgical options in the treatment of hepatic metastasis from colorectal cancer. Curr Problems Surg. 1995;32(5):333–421.
Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239(6):818–25; discussion 825–7.
Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235(6):759–66.
Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004;240(3):438–47; discussion 447–50.
Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241(5):715–22, discussion 722–4.
Elias DD, Sideris LL, Pocard MM, Ouellet JFJ-F, Boige VV, Lasser PP, et al. Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol. 2004;11(3):274–80.
Elias DD, Ouellet JJF, Bellon NN, Pignon JJP, Pocard MM, Lasser PP. Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases. Br J Surg. 2003;90(5):567–74.
Elias DD, Liberale GG, Vernerey DD, Pocard MM, Ducreux MM, Boige VV, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2005;12(11):900–9.
Strasberg SS. Re: Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2007;14(4):1517–8.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 318–21.
Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.
Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg. 2007;205(2):231–8.
Acknowledgment
We would like thank Russell E. Holmes for assistance in data collection and Tina M. Thomas for assistance with manuscript preparation.
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Carpizo, D.R., Are, C., Jarnagin, W. et al. Liver Resection for Metastatic Colorectal Cancer in Patients with Concurrent Extrahepatic Disease: Results in 127 Patients Treated at a Single Center. Ann Surg Oncol 16, 2138–2146 (2009). https://doi.org/10.1245/s10434-009-0521-6
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DOI: https://doi.org/10.1245/s10434-009-0521-6