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Outcome After Resection of Colorectal Liver Metastases: Analysis of 264 Patients
Hannes P. Neeff*1, Oliver Drognitz1, Oliver G. Opitz2, Tobias Keck1, Ulrich T. Hopt1,2, Frank Makowiec1,2
1Dept. of Surgery, University of Freiburg, Freiburg, Germany; 2Comprehensive Cancer Center, University of Freiburg, Freiburg, Germany
Because of low mortality and encouraging survival data resection of liver metastases (LM) of colorectal cancer (CRC) is increasingly peformed in the multimodal management of patients with metastasized CRC. The knowledge of prognostic factors is crucial in the planning of different treatment options. In this study we updated our outcome results in 264 patients after first resection of CRC-LM. Methods: Long-term survival was evaluated in 264 patients after first resection of CRC-LM between 1998 and 2008. Survival analysis was performed by Kaplan-Meier-methods. Independent risk factor analyses for survival were done using Cox’ proportional hazard model. Results: 54% of the 264 patients underwent at least a hemihepatectomy. Free hepatic resection margins were achieved in 88%. Five-year survival (5-Surv) was 44% in the entire study group. By univariate analysis a positive resection margin (5-SURV 34% vs 45%, p=0.001), size of metastases ≥ 3cm (5-SURV 39% vs 52%, p=0.004), number of CRC-LM > one (5-SURV 39% vs 50%, p=0.009) and increased tumor marker levels (CEA > 200 and/or CA 19-9 >100; 5-SURV 30% vs 47%; p=0.03) were risk factors for a poorer outcome. Node positive primary CRC and female gender showed a non-significant trend towards worse survival. In multivariate analysis the resection margin (p=0.02), size of metastases (p<0.001), number of metastases (p=0.006) and increased tumor markers (p<0.01) independently influenced survival. Neoadjuvant chemotherapy (performed in 16%) for CRC-LM did not influence survival but these patients had more and larger metastases than the other patients. Conclusions: In patients with favourable prognostic factors the complete resection of colorectal liver metastases is associated with good long term outcome. Established prognostic factors may be used in the multimodal setting to plan individual therapy. Further advances in perioperative chemotherapy may still increase resection rates or long term outcomes in patients with metastasized CRC.
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