The potential for improved outcome in patients with hepatic metastases from colon cancer: a population-based study.
OBJECTIVE
Reports from specialized centres suggest that 20-25% of patients with hepatic metastases from colorectal cancer have resectable disease, with 5-year survival rates of 30-40%, and that an additional 13-38% may become resectable after chemotherapy. The purpose of this study was to assess the potential for improvement in outcome for patients with hepatic metastases from colon cancer in an unselected population.


METHODS
All patients diagnosed with colon cancer in the Stockholm/Gotland region between 1 January 1996 and 31 December 1999 were identified and followed until 31 December 2002. Treatment and outcome in patients with hepatic metastases was analyzed and CT-scans and MR images of the liver were reviewed to re-evaluate resectability.


RESULTS
In 2280 patients with colon cancer, hepatic metastases were diagnosed in 537 patients. Only 21 of these patients underwent a hepatic resection. Retrospective evaluation of liver images indicated that 10% of the patients had potentially resectable hepatic disease.


CONCLUSIONS
The rate of potentially resectable liver metastases from colon cancer in a population is lower than suggested from hospital-based series. With structured management programs including follow-up routines and multidisciplinary treatment protocols the proportion of patients amenable for liver resection may be increased. In this study preoperative chemotherapy might have increased the resectability rate to at the most 17%. To significantly improve prognosis for patients with hepatic metastases from colon cancer more effective treatment modalities are needed.
Sjövall
A
A
Department of Surgery, Karolinska Hospital, P9:03, Stockholm s-171 76, Sweden. annika.sjovall@kus.se
Järv
V
V
Blomqvist
L
L
Singnomklao
T
T
Cedermark
B
B
Glimelius
B
B
Holm
T
T
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006306:Health Surveys; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology