|
Back to 2018 Posters
THE CHANCE OF CURE FOR PATIENTS WITH COLORECTAL LIVER METASTASIS: LESSONS LEARNED FROM THE OUTCOMES WITH AGGRESSIVE SURGICAL MANAGEMENT IN THE PRE-MODERN CHEMOTHERAPY ERA.
Yoshinori Takeda*1,2, Akio Saiura1, Yoshihiro Mise1, Takeaki Ishizawa1, Yosuke Inoue1, Yu Takahashi1, Hiromichi Ito1
1Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan; 2Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
Background: While liver resection has been considered as the only therapy with "potential for cure" for patients with colorectal liver metastasis (CLM), the real cure rate for those patients remain limited. The aim of this study was to address the chance of cure with aggressive surgical management among patients with CLM in the pre-modern chemotherapy era.
Patients: The cohort included consecutive patients with metastatic colorectal cancer to the liver, who underwent liver resection in our institution from January 1999 through August 2007. Repeat resection was performed for recurrent liver metastases or other extrahepatic lesions whenever R0 resection deemed feasible. No patient received molecular-targeted chemotherapy during this study period. The survival without evidence of disease beyond 10 years following initial hepatectomy for CLM was considered as cure.
Results: The demographics and tumor characteristics for our 257 cohort patients were shown in Table 1. Ten-year overall survival rate for the entire cohort was 37% with median follow-up period for the survivors 139 (120-211) months. Among 93 patients (36%) who achieved cure, 55 patients (59%) did not develop any recurrence after the initial liver resection and the rest underwent repeat liver resection(s) or metastatecomy for recurrences. Although presence of resectable extrahepatic disease at the time of initial liver resection was associated with poorer outcomes, 17% of them achieved cure (compared to 42% for the patients without extrahepatic disease, p<0.001).
Conclusion: Greater than one third of the patients with resectable CLM could be cured with aggressive surgery in the pre-modern chemotherapy era. Post-hepatectomy recurrence or extrahepatic disease dose not necessarily preclude the chance of cure, and more aggressive surgical approach should be warranted in the era of effective modern chemotherapy.
Demographics of all patients
| Variables | All patients (N =257) | | Patient characteristics | | | Age | 63 (27-88) | | Sex (Male) | 154 (60) | | Tumor characteristics | | | Multiple | 155 (60) | | Bilober | 102 (40) | | Size >5cm | 49 (19) | | Synchronous | 118 (46) | | Primary N positive | 170 (66) | | Preoperative CEA >200 ng/ml | 20 (8) | | Extrahepatic disease | 47 (18) | | Lymph node | 16 (6) | | Lung | 15 (6) | | Local | 6 (2) | | Other | 10 (4) |
CLM, colorectal liver metastases; CEA, carcinoembryonic antigen.
Back to 2018 Posters
|
