Abstract
A retrospective study was performed to define patient selection, safety, and efficacy of hepatic resection for colorectal metastases. The recently proposed preoperative clinical risk score (CRS) for selection of patients for surgery was also assessed. In all, 146 consecutive hepatic resections in 137 patients operated in the period between 1977 and 1999 were studied. Of these patients, 113 were classified into five CRS groups. Perioperative mortality was 1.4% (2 patients; no death in 120 patients operated after 1985) and morbidity was 38%. Five-year actuarial survival (perioperative mortality included) was 29% (median 37 months), and actual 5-year survival was 25% (17/69 patients). Patients operated after 1995 lived longer than those operated before 1995. Multiple regression analyses identified preoperative carcinoembryonic antigen CEA<100 µg/L, nodal status at resection of primary tumor, and RO vs. R1/R2 resection as prognostic parameters. CRS grouping had prognostic importance. The relative risk (hazard rate) of tumor recurrence in patients with CRS 3–4 was 2.1, compared to that of patients with CRS 0–2. Five-year actuarial survival in the two groups was 12% and 40%, respectively. Fourteen of 15 long-term survivors (τ;5 years) classified by the CRS system had CRS of 2 or less. Resection for colorectal liver metastases is safe, and long-term survival rates are acceptable. CRS predicts patient outcome, but the clinical role in patient selection will have to be defined in prospective studies.
Resume
Une étude rétrospective a été réalisée pour définir la sélection des patients, la sûreté et l’efficacité de la résection hépatique pour métastases d’origine colorectale. Le score préopératoire «Clinical Risk Score» (CRS), proposé récemment pour la sélection des patients candidats à la chirurgie, a été évalué chez 146 patients consécutifs ayant eu une résection hépatique entre 1977 et 1999; 113 de ces patients ont été classés en cinq groupes selon le CRS. La mortalité périopératoire a été de 1.4% (2 patients; aucune mortalité parmi 120 patients opérés après 1985) et la morbidité, de 38%. La survie actuarielle à 5 ans (mortalité périopératoire incluse) a été de 29% (médiane de 37 mois) et la survie actuelle à 5 ans a été de 25% (17/69 patients). Les patients opérés après 1995 ont survécu plus longtemps que ceux opérés avant 1995. L’analyse par régression multiple a identifié comme facteurs pronostiques, le taux d’ACE inférieur à 100 ng/1, l’état ganglionnaire au moment de la résection tumorale primitive et une résection R0 vs. une résection R1/R2. Le risque relatif de récidive chez les patients CRS 3–4 a été de 2.1 comparé à celui des patients CRS 0–2. La survie actuarielle à 5 ans a été, respectivement, de 12% et de 40%. Quatorze des 15 survivants à long terme (τ; 5 ans), classés par le système CRS, avaient un score de 2 ou moins. La résection des métastases colorectales est sure et la survie à long terme, acceptable. Le score CRS prédit l’évolution mais son rôle clinique dans la sélection des patients reste à être défini par des études prospectives.
Resumen
Para seleccionar de manera eficaz y segura a los pacientes subsidiarios de resección hepática por padecer metástasis en hígado de un cáncer colorrectal, se realiza un estudio retrospectivo, en el que se valoró la clasificación reciente de Riesgo Clínico (CRS). Se estudiaron 146 resecciones hepáticas en 137 pacientes intervenidos entre 1977 y 1999. 113 de estos pacientes se clasificaron en alguno de los cinco grupos de la CRS. La mortalidad perioperatoria fue del 1.4% (2 pacientes; no se registró mortalidad alguna en los 120 pacientes intervenidos después del año 1985) y la morbilidad del 38%. La supervivencia actuarial a los 5 años (incluyendo la mortalidad perioperatoria) fue del 29% (media 37 meses) y la supervivencia actual a los 5 años fue del 25% (17/69 pacientes). Los enfermos intervenidos después de 1995 vivieron más tiempo que los operados con anterioridad. Los análisis de regresión múltiple señalaron como parámetros pronósticos: CEA preoperatorio menor de 100 ng/1, grado de afectación ganglionar en la resección del tumor primario y resección R0 vs R1/R2. La clasificación CRS tiene importancia pronóstica. El riesgo relativo de recidiva tumoral en pacientes de los grupos CRS 3–4 fue 2.1 en relación con la de los grupos CRS 0–2. La supervivencia actuarial a los 5 años fue respectivamente del 12% y 40%. 14 de los 15 supervivientes a largo plazo (τ;5 años) clasificados con el sistema CRS pertenecían a los grupos CRS 2 ó menores. El sistema CRS permite pronosticar los resultados, pero el papel del estudio clínico en la selección de los pacientes ha de definirse mejor en próximos estudios prospectivos.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Fong Y, Fortner J, Sun R. et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann. Surg. 1999;230:309
Fong Y, Blumgart L. Hepatic colorectal metastasis: current status of surgical therapy. Oncology 1998;12:1489
Ohlsson B, Stenram U. Resection of colorectal liver metastases: 25-year experience. World J. Surg. 1998;22:268
Nordlinger B, Guiget 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. Cancer 1996;77:1254
Scheele J, Stang R, Altendorf-Holtmann A, et al. Resection of colorectal metastases. World J. Surg. 1995;19:59
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
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery 1986;100:278
Doci R, Gennari L, Bignami P. et al. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br. J. Surg. 1991;78:797
Couinaud C (1957) Le foie. Etudes Anatomiques et Chirugicales. Masson & Cie. Paris
Akaike H. A new look at the statistical model identification. IEEE Trans. Auto. Cont. AC 1974;19:716
Doci R, Gennari L, Bignami P. et al. Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br. J. Surg. 1995;82:377
Fong Y, Brennan MF, Cohen AM, et al. Liver resection in the elderly. Br. J. Surg. 1997;84:1386
Harmon K, Ryan JA Jr, Biehl TR. et al. Benefits and safety of hepatic resection for colorectal metastases. Am. J. Surg. 1999;177:402
Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatcetomies in the 1990s: an update to evaluate the aetual risk of liver resection. J. Am. Coll. Surg. 2000;1:38
Gayowski TJ, Iwatsuki S, Madariaga JR, et al. Experience in hepatic resection for colorectal cancer; analysis of clinical and pathological risk factors. Surgery 1994;116:703
Bakalakos EA, Kim JA, Young DC, et al. Determinants of survival following hepatic resection for metastatic colorectal cancer. World J. Surg. 1998;22:399
Ambiru S, Miyazaki M, Isono T, et al. Hepatic resection for colorectal metastases-analysis of prognostic factors. Dis. Colon Rectum 1999;42:632
Jamison RL, Donohue JH, Nagorney DM, et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch. Surg. 1997;132:505
Scheele J, Stangl R, Altendorf-Hofmann A, et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991;110:13
Elias D, Cavalcanti A, Sabourin JC et al. Resection of liver metastases from colorectal cancer; the real impact of the surgical margin. Eur. J. Surg. Oncol. 1998;24:174
Fegiz G, Ramacciato G, Gennari L, et al. Hepatic resection for colorectal metastases: the Italian multicenter experience. J. Surg. Oncol. 1991;Suppl. 2:144
Fortner JG, Silva JS, Golbey RB, et al. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. 1—Treatment by hepatic resection. Ann. Surg. 1984;199:306
Wanebo HJ, Chu QD, Vezeridis MP, et al. Patient selection for hepatic resection of colorectal metastases. Arch. Surg. 1996;131:322
Crucitti F, Doglietto GB, Bellantone R, et al. Accurate specimen preparation and examination is mandatory to detect lymph nodes and avoid understaging in colorectal cancer. J. Surg. Oncol. 1992;51:153
Sobin LH, Wittekind CH, editors. TNM Classification of Malignant Tumours. International Union Against Cancer, 5th edition. New York, Wiley-Liss, 1997
Goldstein NS, Sandford W, Coffey M, et al. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and recommendation for a minimum number of lymph nodes to be recovered. Am. J. Clin. Pathol. 1996;106:209
Author information
Authors and Affiliations
Corresponding author
Additional information
Published Online: September 26, 2002
Rights and permissions
About this article
Cite this article
Mala, T., Bøhler, G., Mathisen, Ø. et al. Hepatic resection for colorectal metastases: Can preoperative scoring predict patient outcome?. World J. Surg. 26, 1348–1353 (2002). https://doi.org/10.1007/s00268-002-6231-x
Issue Date:
DOI: https://doi.org/10.1007/s00268-002-6231-x