The prognosis of liver resection for patients with four or more colorectal liver metastases has not improved in the era of modern chemotherapy.
OBJECTIVE
The impact of perioperative chemotherapy on patients with multiple colorectal liver metastases (CRLM) remains unclear. We attempted to examine whether the introduction of modern chemotherapies has improved the prognosis of patients that undergo liver resection for ≥4 CRLM.


METHODS
Between January 1990 and December 2013, 194 patients underwent liver resection for CRLM at our institution. The outcomes of the patients with ≥4 and 1-3 CRLM were compared before and after 2005, when modern chemotherapies were introduced to Japan.


RESULTS
There were 50 and 144 patients with ≥4 (Group 1) and 1-3 (Group 2) CRLM, respectively. The overall survival (OS) rate of Group 1 was significantly worse than that of Group 2 (P = 0.0007). The OS rate of Group 2 was significantly better after 2005 than before 2004 (P = 0.039), while no such differences were observed in Group 1. Multivariate analysis identified three prognostic factors in Group 1: a serum carcinoembryonic antigen level of ≥20 ng/ml (P = 0.018), a serum cancer antigen 19-9 level of ≥100 U/ml (P = 0.018), and a primary colorectal cancer N factor of ≥N2 (P = 0.023).


CONCLUSIONS
The prognosis of patients with ≥4 CRLM that undergo liver resection has not improved despite the development of modern chemotherapies. J. Surg. Oncol. 2016;114:959-965. © 2016 Wiley Periodicals, Inc.
Department of Surgery, Nara Medical University, Nara, Japan.
Daisuke
D
Hokuto
Department of Surgery, Nara Medical University, Nara, Japan.
Takeo
T
Nomi
Department of Surgery, Nara Medical University, Nara, Japan.
Ichiro
I
Yamato
Department of Surgery, Nara Medical University, Nara, Japan.
Satoshi
S
Yasuda
Department of Surgery, Nara Medical University, Nara, Japan.
Shinsaku
S
Obara
Department of Surgery, Nara Medical University, Nara, Japan.
Takahiro
T
Yoshikawa
Department of Surgery, Nara Medical University, Nara, Japan.
Chihiro
C
Kawaguchi
Department of Surgery, Nara Medical University, Nara, Japan.
Takatsugu
T
Yamada
Department of Surgery, Nara Medical University, Nara, Japan.
Hiromichi
H
Kanehiro
Department of Surgery, Nara Medical University, Nara, Japan.
Yoshiyuki
Y
Nakajima
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil
adjuvant chemotherapy; colorectal liver metastasis; liver resection; multiple liver metastases