Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis.
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.
Lee
Won-Suk
WS
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
Kim
Min Jung
MJ
Yun
Seong Hyeon
SH
Chun
Ho-Kyung
HK
Lee
Woo Yong
WY
Kim
Sung-Joo
SJ
Choi
Seong-Ho
SH
Heo
Jin-Seok
JS
Joh
Jae Won
JW
Kim
Yong Il
YI
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