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. 2010 Sep 27:10:27.
doi: 10.1186/1471-2482-10-27.

Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis

Michihiro Hayashi  1 , Yoshihiro Inoue, Koji Komeda, Tetsunosuke Shimizu, Mitsuhiro Asakuma, Fumitoshi Hirokawa, Yoshiharu Miyamoto, Junji Okuda, Atsushi Takeshita, Yuro Shibayama, Nobuhiko Tanigawa
Affiliations

Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis

Michihiro Hayashi et al. BMC Surg. .

Abstract

Background: Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors.

Methods: Eighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.

Results: The overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly.

Conclusions: Optimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above.

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Figures

Figure 1
Figure 1
Survival curves according to portal vein invasion in the resected liver specimen. No portal vein invasive disease is denoted as "port (-)". Invasion confined to the portal vein is arbitrarily designated as "port (+)". Portal vein invasion was observed in 8 patients with the significant worse 3- and 5 year survival when compared with those without portal invasion (28.6% and 0% vs. 66.2% and 63.4%, respectively, P = 0.0074).
Figure 2
Figure 2
Survival curves according to surgical margin in the resected liver specimen. A surgical margin of 5 mm or wider is denoted as "≥ 5 mm". A surgical margin narrower than 5 mm is denoted as "< 5 mm". Patients with a surgical margin of 5 mm or wider had a better survival rate than those with a narrower resection margin (P = 0.0399).
Figure 3
Figure 3
Survival curves according to the presence of intrahepatic recurrence after the initial hepatectomy. The presence of recurrence is denoted as "(+)" and absence "(-)". The presence of intrahepatic recurrence were associated with a significant difference in survival after initial hepatectomy (P = 0.0104).
Figure 4
Figure 4
Survival curves according to the presence of extrahepatic recurrence after the initial hepatectomy. The presence of recurrence is denoted as "(+)" and absence "(-)". The presence of extrahepatic recurrence were associated with a significant difference in survival after initial hepatectomy (P = 0.0217).
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