title: Technical and biological factors in disease-free survival after hepatic resection for colorectal cancer metastases.
abstract: Careful patient selection for hepatic resection of colorectal cancer metastases is essential to improve current poor results. Carcinoembryonic antigen level and number of metastases were significant preoperative prognostic indicators of 5-year disease-free survival in patients selected clinically for hepatic surgery. Surgical margin, weight of hepatic tissue resected, carcinoembryonic antigen level, and flow cytometry were significant postoperative prognostic indicators. Patients with a carcinoembryonic antigen level less than 200 ng/mL, 1-cm surgical margins, and less than 1,000 g of liver tissue removed had a greater than 50% estimated 5-year disease-free survival rate. If the metastases were diploid on flow cytometry, an additional survival advantage may have been gained. Inadequate surgical margins led to high rates of liver-only recurrence. Nonhepatic recurrence was unrelated to surgical margins. Intraoperative liver examination by ultrasound during primary colon cancer resection and adjuvant chemotherapy may offer earlier selection of biologically appropriate patients and improved outcome; both recommendations require clinical trials.
authors.affiliation: Division of Surgical Oncology, New England Deaconess Hospital, Boston, Mass. 02215.
authors.forename: B
authors.initials: B
authors.lastname: Cady
authors.forename: M D
authors.initials: MD
authors.lastname: Stone
authors.forename: W V
authors.initials: WV
authors.lastname: McDermott
authors.forename: R L
authors.initials: RL
authors.lastname: Jenkins
authors.forename: A
authors.initials: A
authors.lastname: Bothe
authors.forename: P T
authors.initials: PT
authors.lastname: Lavin
authors.forename: E J
authors.initials: EJ
authors.lastname: Lovett
authors.forename: G D
authors.initials: GD
authors.lastname: Steele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000150:complications*; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality / Q000592:standards*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen