title: Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis.
abstract: OBJECTIVE
  This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection.
  
  
  METHODS
  A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive liver resection margin were excluded from the analysis.
  
  
  RESULTS
  At multivariate level, poor prognostic factors were liver resection margin < or =5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010-2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499-4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020-2.789), and lymph node > or = 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158-3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low risk group, 0-1 factor; intermediate risk group, 2 factors; high-risk group, 3-4 factors. Of 135 patients, 86 patients (63.0%) were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group. Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7-62.4), and 23.5 months (95% CI, 9.4-31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6-6.0) increased risk of death.
  
  
  CONCLUSIONS
  A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival. The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system needs further prospective validation.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Lee
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yun
authors.forename: Ho-Kyung
authors.initials: HK
authors.lastname: Chun
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Sung-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012007:Rectum / Q000473:pathology; D012307:Risk Factors