Surgical outcomes and prognostic factors in patients with synchronous colorectal liver metastases.
BACKGROUND
Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection.


METHODS
Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest.


RESULTS
Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥ 50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months.


CONCLUSIONS
Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.
Universidade de Caxias do Sul, Faculdade de Medicina, Caxias do Sul, RS, Brasil.
Rafael
R
Fontana
Paulo
P
Herman
Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil.
Paulo
P
Hermam
Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil.
Vincenzo
V
Pugliese
Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil.
Marcos Vinicius
MV
Perini
Fabricio Ferreira
FF
Coelho
Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil.
Fabricio Ferreira
FF
Velho
Universidade de São Paulo, Faculdade de Medicina, Departmento de Gastroenterologia, São Paulo, SP, Brasil.
Ivan
I
Cecconello
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
D002272:Carcinoembryonic Antigen