Outcome After Resection of Colorectal Liver Metastases: No Prognostic Influence of Complications, Blood Transfusions or Body Mass Index
Frank Makowiec*, Hannes P. Neeff, Andrea Klock, Oliver Drognitz, Ulrich T. Hopt
Dept. of Surgery, University of Freiburg, Freiburg, Germany
Because of low mortality and steadily improving outcomes liver resection for colorectal metastases (CRC-LM) is increasingly used as a part of multimodal therapy of metastasized CRC. In addition to established oncological parameters (e.g.; Fong criteria) factors like BMI, perioperative blood transfusions and postoperative complications were discussed for an influence on long term prognosis. We, therefore, evaluated our survival data for prognostic factors including above mentioned parameters. Methods: Long term outcome could be assessed in 267 patients (76% male, 50% synchronous CRC-LM) after first liver resection for CRC-LM since 1998. Perioperative blood transfusions were given in 29%. Postoperative morbidity (any complication) was 52%. Survival was analyzed by a Kaplan-Meier-method and Cox-regression model. Results: Free hepatic margins were achieved in 88%. Overall five year survival was 45%. In univariate analysis positive hepatic margins (p<0.01), CRC-LM size ≥ 3cm (p=0.005), increased tumor markers (CA 19-9 > 100 and/or CEA > 200; p=0.01) and node positive primary CRC (p=0.05) were associated with poorer survival. In multivariate analysis CRC-LM size (p<0.01), node positive primary CRC (p<0.05) and increased tumor markers (p<0.05) independently influenced prognosis. The hepatic resection status showed a trend but no significant prognostic influence. Synchronous and metachronous metastases had almost identical outcomes. The occurrence of postoperative complications (any, as well as hepatic or infectious complications), BMI and perioperative blood transfusions did not show any influence on long term prognosis.Conclusions: In our study long term prognosis after first resection of colorectal LM was mainly influenced by established tumor-related parameters. As recently shown by other groups the resection margin had only a minor influence (maybe due to further multimodal or repeat therapy). Further examined factors like perioperative complications, perioperative blood transfusions or body mass index did not influence the outcome in our experience.
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