Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results

Abstract

Objective: To evaluate retrospectively the long-term results of an approach consisting of performing surgery in every patient in whom radical removal of all metastatic disease was technically feasible.

Summary background data: The indications for surgical resection for liver metastases from colorectal cancer remain controversial. Several clinical risk factors have been reported to influence survival.

Methods: Between March 1980 and December 1997, 235 patients underwent hepatic resection for metastatic colorectal cancer. Survival rates and disease-free survival as a function of clinical and pathologic determinants were examined retrospectively with univariate and multivariate analyses.

Results: The overall 3-, 5-, 10-, and 15-year survival rates were 51%, 38%, 26%, and 24%, respectively. The stage of the primary tumor, lymph node metastasis, and multiple nodules were significantly associated with a poor prognosis in both univariate and multivariate analyses. Disease-free survival was significantly influenced by lymph node metastasis, a short interval between treatment of the primary and metastatic tumors, and a high preoperative level of carcinoembryonic antigen. The 10-year survival rate of patients with four or more nodules (29%) was better than that of patients with two or three nodules (16%), and similar to that of patients with a solitary lesion (32%).

Conclusions: Surgical resection is useful for treating liver metastases from colorectal cancer. Although multiple metastases significantly impaired the prognosis, the life expectancy of patients with four or more nodules mandates removal.

Figure 1. Overall and disease-free survival rates of 235 patients after the first hepatic resection.

Figure 2. Survival rate according to whether the interval between colorectal resection and hepatectomy was 3 months or less or more than 3 months (P = .008).

Figure 3. Survival rate according to whether the lesion involved a solitary metastasis or multiple metastases (P = .003).

Figure 4. Survival rate according to the number of metastases at the first hepatectomy: one nodule versus two or three deposits (P = .001), one versus four or more (NS), and two or three versus four or more (NS).

Figure 5. Survival rate according to preoperative level of carcinoembryonic antigen: less than 50 ng/mL versus 50 ng/mL or more (P = .07).