title: The pre-operative rate of growth of colorectal metastases in patients selected for liver resection does not influence post-operative disease-free survival.
abstract: OBJECTIVE
  To assess the potential association between the change in diameter of colorectal liver metastases between pre-operative imaging and liver resection and disease-free survival in patients who do not receive pre-operative liver-directed chemotherapy.
  
  
  METHODS
  Analysis of a prospectively maintained database of patients undergoing liver resection for colorectal liver metastases between 2005 and 2012 was undertaken. Change in tumour size was assessed by comparing the maximum tumour diameter at radiological diagnosis determined by imaging and the maximum tumour diameter measured at examination of the resected specimen in 157 patients.
  
  
  RESULTS
  The median interval from first scan to surgery was 99 days and the median increase in tumour diameter in this interval was 38%, equivalent to a tumour doubling time (DT) of 47 days. Tumour DT prior to liver resection was longer in patients with T1 primary tumours (119 days) than T2-4 tumours (44 days) and shorter in patients undergoing repeat surgery for intra-hepatic recurrence (33 days) than before primary resection (49 days). The median disease-free survival of the whole cohort was 1.57 years (0.2-7.3) and multivariate analysis revealed no association between tumour DT prior to surgery and disease-free survival.
  
  
  CONCLUSIONS
  The rate of growth of colorectal liver metastases prior to surgery should not be used as a prognostic factor when considering the role of resection.
authors.affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK; Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, John Bull Building, Plymouth, Devon PL6 8BU, UK. Electronic address: matthew.wiggans@doctors.org.uk.
authors.forename: M G
authors.initials: MG
authors.lastname: Wiggans
authors.affiliation: School of Science and Technology, Nottingham Trent University, Nottingham NG1 4BU, UK. Electronic address: golnaz.shahtahmassebi@ntu.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Shahtahmassebi
authors.affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK. Electronic address: s.aroori@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Aroori
authors.affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK. Electronic address: matthewbowles@nhs.net.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bowles
authors.affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK. Electronic address: christopherbriggs@nhs.net.
authors.forename: C
authors.initials: C
authors.lastname: Briggs
authors.affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK; Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, John Bull Building, Plymouth, Devon PL6 8BU, UK. Electronic address: david.stell@nhs.net.
authors.forename: D A
authors.initials: DA
authors.lastname: Stell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal; Liver; Metastasis; Resection