title: Surgical technique and systemic inflammation influences long-term disease-free survival following hepatic resection for colorectal metastasis.
abstract: BACKGROUND
  To date, there is limited data available on prognostic factors that influence long-term disease-free survival following hepatic resection for colorectal liver metastasis (CRLM). The aim of the study was to identify prognostic factors that were associated with long-term disease-free survival (>5 years) following resection for CRLM.
  
  
  METHODS
  Patients undergoing resection for CRLM from January 1993 to March 2007 were identified from the hepatobiliary database. Data analyzed included demographics, laboratory results, operative findings and histopathological data.
  
  
  RESULTS
  Seven hundred five curative primary hepatic resections were performed, of which 434 patients developed disease recurrence within 5 years and 67 patients were disease-free more than 5 years. There was a significant association between systemic inflammatory response (raised neutrophil to lymphocyte ratio and/or C-reactive protein), blood transfusion, >2 tumors, bilobar disease and resection margin involvement with developing recurrence during the follow-up period. On multivariate analysis, three independent predictors for recurrent disease within the 5-year follow-up were identified: pre-operative inflammatory response; blood transfusion requirement; and status of resection margin.
  
  
  CONCLUSIONS
  Absence of a systemic inflammatory response and surgical technique to minimize transfusion requirements and obtain a R0 resection margin, are associated with long-term disease-free survival.
authors.affiliation: Hepatobiliary and Transplantation Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: Judy
authors.initials: J
authors.lastname: Wyatt
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome