Abstract
Introduction
Hepatic resection may offer long-term survival for patients with colorectal metastases. However, controversies exist regarding the prognostic factors. Herein, the impact of synchronicity of liver metastasis on patient clinicopathological features and prognosis was evaluated.
Methods
One hundred and fifty-five patients who underwent hepatectomy for colon cancer metastasis, from 1995 to 2004, were enrolled in this study. Patients were divided into two groups: synchronous and metachronous colorectal liver metastasis. Patient demographics, the nature of the primary and metastatic tumors, surgery-related complications, and long-term outcome were analyzed.
Results
Patients included in the synchronous group tended to be younger than those in the metachronous group. Compared to the metachronous group, patients in the synchronous group showed more metastases (P = 0.008) and bilobarly distributed metastases (P = 0.016). Bile leakage was the most common surgical complication. The estimated 5-year disease-free and overall survival rates were 16.8 and 41.1%, respectively. Univariate analysis indicated that synchronous metastases, advanced stage of the primary tumor, bilobar distribution of the metastases, more than three metastases, and colonic versus rectal location of the primary tumor were prognostic factors of shorter disease-free survival, but not overall survival. Multivariate analysis revealed that synchronous metastases and the advanced stage of the primary tumor were indicators for a worse disease-free survival.
Conclusion
The synchronous presence of primary colon cancer and liver metastasis may indicate a more disseminated disease status and is associated with a shorter disease-free survival than metachronous metastasis. These patients may need more careful monitoring and aggressive chemotherapy following curative resection.
Similar content being viewed by others
References
Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997; 15:938–46
Scheele J, Altendorf-Hofmann A. Resection of colorectal liver metastases. Langenbecks Arch Surg 1999; 84:313–27
Adam R, Bismuth H, Castaing D, et al. Repeat hepatectomy for colorectal liver metastases. Ann Surg 1997; 225:51–60
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230:309–18
Harmon KE, Ryan JA, Jr., Biehl TR, et al. Benefits and safety of hepatic resection for colorectal metastases. Am J Surg 1999; 177:402–4
Holm A, Bradley E, Aldrete JS. Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrence. Ann Surg 1989; 209:428–34
Sugihara K, Hojo K, Moriya Y, et al. Pattern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993; 80:1032–5
Ueno H, Mochizuki H, Hatsuse K, et al. Indicators for treatment strategies of colorectal liver metastases. Ann Surg 2000; 231:59–66
Taylor M, Forster J, Langer B, et al. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg 1997; 173:467–71
Wanebo HJ, Chu QD, Vezeridis MP, et al. Patient selection for hepatic resection of colorectal metastases. Arch Surg 1996; 131:322–9
Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996; 77:1254–62
Shirabe K, Takenaka K, Gion T, et al. Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin. Br J Surg 1997; 84:1077–80
Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235:759–66
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239:818–25
Adson MA, van Heerden JA, Adson MH, et al. Resection of hepatic metastases from colorectal cancer. Arch Surg 1984; 119:647–51
Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum 1988; 31:1–4
Stone MD, Cady B, Jenkins RL, et al. Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg 1990; 125:718–21
Huguet C, Bona S, Nordlinger B, et al. Repeat hepatic resection for primary and metastatic carcinoma of the liver. Surg Gynecol Obstet 1990; 171:398–402
Fowler WC, Hoffman JP, Eisenberg BL. Redo hepatic resection for metastatic colorectal carcinoma. World J Surg 1993; 17:658–61
Nordlinger B, Vaillant JC, Guiguet M, et al. Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie. J Clin Oncol 1994; 12:1491–6
Konishi K, Fujii T, Boku N, et al. Clinicopathological differences between colonic and rectal carcinomas: are they based on the same mechanism of carcinogenesis? Gut 1999; 45:818–21
Iacopetta B. Are there two sides to colorectal cancer? Int J Cancer 2002; 101:403–8
Valls C, Andia E, Sanchez A, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology 2001; 218:55–60
Strasberg SM, Dehdashti F, Siegel BA, et al. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg 2001; 233:293–9
Cervone A, Sardi A, Conaway GL. Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions. Am Surg 2000; 66:611–5
Paul MA, Mulder LS, Cuesta MA, et al. Impact of intraoperative ultrasonography on treatment strategy for colorectal cancer. Br J Surg 1994; 81:1660–3
Malafosse R, Penna C, Sa Cunha A, et al. Surgical management of hepatic metastases from colorectal malignancies. Ann Oncol 2001; 12:887–94
Wanebo HJ, Chu QD, Avradopoulos KA, et al. Current perspectives on repeat hepatic resection for colorectal carcinoma: a review. Surgery 1996; 119:361–71
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsai, MS., Su, YH., Ho, MC. et al. Clinicopathological Features and Prognosis in Resectable Synchronous and Metachronous Colorectal Liver Metastasis. Ann Surg Oncol 14, 786–794 (2007). https://doi.org/10.1245/s10434-006-9215-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-006-9215-5