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. 2023 Mar 10;12(6):2170.
doi: 10.3390/jcm12062170.

Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience

Matteo Pagani  1 , Rosita De Vincenti  1 , Carolina Cecchi  1 , Alice Apollinari  1 , Benedetta Pesi  1 , Francesca Leo  1 , Sandro Giannessi  1 , Massimo Fedi  1
Affiliations

Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience

Matteo Pagani et al. J Clin Med. .

Abstract

Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The aim of this study is to analyze the main prognostic factors related to overall and disease-free survival of a series of consecutive patients undergoing liver resection for colorectal liver metastases (CRLM).

Materials and methods: A retrospective review of patients undergoing liver resection for CRLM between April 2018 and September 2021 was performed. Clinical data and laboratory parameters were evaluated using the log-rank test. OS and DFS were estimated using the Kaplan-Meier method.

Results: A retrospective study on 75 patients who underwent liver resection for CRLM was performed. The OS and DFS at 1 and 3 years were 84.3% and 63.8% for OS, 55.6% and 30.7% for DFS, respectively. From the analysis of the data, the most significant results indicate that: patients with a lower CEA value <25 ng/mL had an OS of 93.6% and 80.1% at 1 and 3 years, with an average of 36.7 months (CI 95% 33.1-40.3); moreover, patients with a value equal to or greater than 25 ng/mL had a 1-year survival equal to 57.4%, with an average of 13.8 months (CI 95% 9.4-18.2) (p < 0.001); adjuvant chemotherapy increases by 3 years the overall survival (OS: 68.6% vs. 49.7%) (p = 0.013); localization of the primary tumor affects OS, with a better prognosis for left colon metastases (OS at 42 months: 85.4% vs. 42.2%) (p value = 0.056); patients with stage T1 or T2 cancer have a better 3 years OS (92.9-100% vs. 49.7-56.3%) (p = 0.696), while the N0 stage results in both higher 3 years OS and DFS than the N + stages (OS: 87.5% vs. 68.5% vs. 24.5%); metachronous metastases have a higher 3 years OS than synchronous ones (80% vs. 47.4%) (p = 0.066); parenchymal sparing resections have a better 3 years DFS than anatomical ones (33.7% vs. 0%) (p = 0.067); a patient with a parenchymal R1 resection has a much worse prognosis than an R0 (3 years OS: 0% vs. 68.7%) (p < 0.001).

Conclusions: CEA value of less than 25 ng/mL, localization of the primary tumor in the left colon, primary tumor in stage T1/2 and N0, metachronous presentation, R0 resection, fewer than four metastases, and use of adjuvant chemotherapy are all parameters that in our analysis have shown a correlation with a better prognosis; moreover, the evaluation of the series is in line with the latest evidence in the literature in defining the non-inferiority of minimally invasive and parenchymal sparing treatment compared to the classic laparotomic approach with anatomic resection.

Keywords: colorectal cancer; liver metastases; liver resection; prognostic factors; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier curve for OS and DFS in patients who underwent liver resection for CRLM stratified based on the temporal presentation of metastasis (synchronous/metachronous). OS: overall survival; DFS: disease free survival; CRLM: colorectal liver metastases.
Figure 2
Figure 2
Kaplan-Meier curve for OS and DFS in patients who underwent liver resection for CRLM stratified based on the primary tumor site. (Left colon, right colon, rectum). OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastases.
Figure 3
Figure 3
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to the primary tumor’s T stage. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
Figure 4
Figure 4
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to the primary tumor’s N stage. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
Figure 5
Figure 5
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to CEA values. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.CEA carcinoembryonic antigen.
Figure 6
Figure 6
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according whether the patient had adjuvant chemotherapy or not: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis; CHT: chemotherapy.
Figure 7
Figure 7
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to type for surgical technique used. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis. Open; VL-video laparoscopy.
Figure 8
Figure 8
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to type of hepatic resection. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
Figure 9
Figure 9
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to lobar involvement. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
Figure 10
Figure 10
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to number of lesions removed. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
Figure 11
Figure 11
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to the status of histological margin infiltration. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis; R1p: parenchymal R1; R1v: vascular R1.
Figure 12
Figure 12
Kaplan-Meier Curve for OS and DFS in patients who underwent liver resection for CRLM stratified according to distance between lesion and surgical margin. OS: Overall Survival; DFS: Disease Free Survival; CRLM: Colorectal liver metastasis.
See this image and copyright information in PMC

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