title: Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy.
abstract: The outcome of patients with colorectal liver metastases (CLM) undergoing surgical resection in the era of effective chemotherapy is not widely reported. In addition, factors associated with disease-specific survival (DSS) in a contemporary series of patients are not well defined. Clinical, pathologic, and outcome data for 64 patients with CLM treated by a single surgeon in a multidisciplinary setting from February 2002 to October 2007 were examined. Hepatic resection was combined with radiofrequency ablation (RFA) in 23 (36%) cases. Secondary or tertiary resection was undertaken in 12 (19%) patients. Synchronous CLM were noted in 25 (39%) cases. Neoadjuvant chemotherapy was given to 41 (64%) patients. Following hepatic resection, adjuvant chemotherapy was administered in 52 (81%) cases. There was one (2%) operative mortality. One or more complications were noted in 24 (38%) patients. Median length of hospital stay was 7 (2-7) days. Five-year DSS and overall survival were 72% and 69%, respectively. Bilobar disease (p < 0.001), local tumor extension (p = 0.02), response to neoadjuvant chemotherapy (p = 0.005), preoperative portal vein embolization (p = 0.05), number of hepatic lesions (p = 0.03), positive resection margin (p < 0.001), and node-positive primary disease (p = 0.001) were prognostically significant factors on univariate analysis. On multivariate analysis, bilobar disease (p = 0.02) and local tumor extension (p = 0.02) were the only two independent prognostic factors. We conclude that, in patients with CLM, a multidisciplinary approach encompassing an aggressive surgical policy achieves excellent 5-year survival results with acceptable operative morbidity and mortality. Bilobar disease and local extrahepatic extension of cancer appear to be independent prognostic factors for long-term survival.
authors.affiliation: Department of Surgery, Program for Liver, Pancreas and Foregut Tumors, Penn State College of Medicine, Hershey, PA 17033-0850, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Nikfarjam
authors.forename: Serene
authors.initials: S
authors.lastname: Shereef
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.forename: Yixing
authors.initials: Y
authors.lastname: Jiang
authors.forename: Diego M
authors.initials: DM
authors.lastname: Avella
authors.forename: Rickhesvar P
authors.initials: RP
authors.lastname: Mahraj
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents