title: Trends in long-term survival following liver resection for hepatic colorectal metastases.
abstract: OBJECTIVE
  To examine trends in outcomes of patients undergoing resection at a single tertiary care referral center over a 16-year period.
  
  
  BACKGROUND
  Hepatic resection is considered the treatment of choice in selected patients with colorectal metastasis confined to the liver. Although a variety of retrospective studies have demonstrated improvements in short-term outcomes in recent years, changes in long-term survival over time are less well-established.
  
  
  METHODS
  Data from 226 consecutive patients undergoing potentially curative liver resection for colorectal metastases between 1984 and 1999 were analyzed. Actuarial survival rates related to prognostic determinants were analyzed using the log-rank test.
  
  
  RESULTS
  The median survival for the entire cohort was 46 months, with 5- and 10-year survival rates of 40% and 26% respectively. Ninety-three patients operated on between 1984 and 1992 were found to have an overall survival of 31% at 5 years, compared to 58% for the 133 patients operated on during the more recent period (1993-1999). Both overall and disease-free survival were significantly better in the recent time period compared with the earlier period on both univariate and multivariate analyses. Other independent factors associated with improved survival included number of metastatic tumors < or = 3, negative resection margin, and CEA < 100. Comparisons were made between time periods for a variety of patient, tumor and treatment-related factors. Among all parameters studied, only resection type (anatomical versus nonanatomical), use of intraoperative ultrasonography, and perioperative chemotherapy administration differed between the early and recent time periods.
  
  
  CONCLUSIONS
  Long-term survival following liver resection for colorectal metastases has improved significantly in recent years at our institution. Although the reasons for this survival trend are not clear, contributing factors may include the use of newer preoperative and intraoperative imaging, increased use of chemotherapy, and salvage surgical therapy.
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. mchoti@jhmi.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: James V
authors.initials: JV
authors.lastname: Sitzmann
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Tiburi
authors.forename: Wuthi
authors.initials: W
authors.lastname: Sumetchotimetha
authors.forename: Ram
authors.initials: R
authors.lastname: Rangsin
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen