title: Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases.
abstract: OBJECTIVE
  Survival analyses after hepatectomy for colorectal liver metastases (CRLM) mostly address tumor-related factors; this study has simultaneously evaluated interventional factors which may be influenced by the surgeon.
  
  
  METHODS
  Operative and long-term results of 251 consecutive patients undergoing hepatectomy for CRLM between 1992 and 2007 were analyzed.
  
  
  RESULTS
  Mortality was 0.8%, morbidity 22.9%, intraoperative blood transfusion rate 23.1% (19.4% with pedicle clamping, 35.0% without clamping, P = 0.01), R0-resection 93.6% (2/3 with tumor-free margin >5 mm). The 3-, 5-, 10-year overall and disease-free survival rates were 55.2%, 38.9%, 24.2%, and 37.1%, 28.2%, 25.4%. Univariate analysis: lower survival was related to transfusion requirement, tumor size >5 cm, tumor-free margin < or =5 mm, major hepatectomy, R1-resection, multiplicity of CRLM, preoperative CEA > or =50 ng/ml. Multivariate analysis: intraoperative transfusion remained the only independent predictor of survival; tumor-free margin < or =5 mm and multiplicity of CRLM remained independent predictors of disease-free survival within 12 months from hepatectomy; intraoperative transfusion became again the prominent predictor for later recurrences.
  
  
  CONCLUSIONS
  Two factors may be influenced by the surgeon: bleeding with requirement for blood transfusion (through the protective effect of pedicle clamping) and width of tumor-free surgical margin. These factors have prominent roles on long-term outcomes after hepatectomy for CRLM.
authors.affiliation: Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.forename: Maria
authors.initials: M
authors.lastname: Vellone
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Ranucci
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003250:Constriction; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010819:Physician's Role; D011446:Prospective Studies