title: Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases.
abstract: BACKGROUND
  Survival after resection of colorectal liver metastases may be influenced by the patient, the primary tumour and the liver metastases. Postoperative morbidity is associated with poor survival in several cancers. The aim of this retrospective study was to evaluate prognostic factors of survival after resection of colorectal liver metastases, including postoperative morbidity.
  
  
  METHODS
  From 1985 to 2000, 311 consecutive patients with liver metastases from colorectal cancer underwent resection with curative intent. Univariate and multivariate analyses were performed to assess the influence of age, sex, site and stage of the colorectal tumour, disease-free interval, number, size and distribution of metastases, type of hepatectomy, pedicular clamping, resection margin, blood transfusion, postoperative morbidity and adjuvant chemotherapy on overall and disease-free survival.
  
  
  RESULTS
  The postoperative mortality and morbidity rates were 3 and 30 per cent respectively. The 3- and 5-year overall survival rates were 53 and 36 per cent respectively. Both overall and disease-free survival rates were independently associated with nodal status of the colorectal tumour, number of metastases and postoperative morbidity. Patients with postoperative morbidity had an overall and disease-free 5-year survival rate half that of patients with no morbidity: 21 versus 42 per cent for overall survival (P < 0.001) and 12 versus 28 per cent for disease-free survival (P = 0.001) respectively.
  
  
  CONCLUSIONS
  Long-term survival can be altered by postoperative morbidity after resection of colorectal liver metastases by increasing the risk of tumour recurrence. This justifies optimizing the surgical treatment of colorectal liver metastases to decrease postoperative morbidity and the use of efficient adjuvant treatments in patients with postoperative morbidity.
authors.affiliation: Department of Surgery, Hôpital Saint-André, 33075 Bordeaux, France. christophe.laurent@chu-bordeaux.fr
authors.forename: C
authors.initials: C
authors.lastname: Laurent
authors.forename: A
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: P
authors.initials: P
authors.lastname: Couderc
authors.forename: E
authors.initials: E
authors.lastname: Rullier
authors.forename: J
authors.initials: J
authors.lastname: Saric
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate