Prognostic Analysis of 102 Patients with Synchronous Colorectal Cancer and Liver Metastases Treated with Simultaneous Resection

Zhang, Ye Fan; Mao, Rui; Chen, Xiao; Zhao, Jian; Bi, Xin; Li, Zhi Yu; Zhou, Jian; Zhao, Hong; Huang, Zhen; Sun, Yong; Cai, Jian

doi:10.4103/0366-6999.206349

Cited by 7 publications

(12 citation statements)

References 13 publications

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“…The prognosis of patients with CRLM with simultaneous resection of CRC and liver metastases is still not satisfactory. Overall, 75% (7) of patients still experience recurrence after surgery; the 5-year progression-free survival (PFS) and OS rates are only 21.2% and 46.4%, respectively (8). The incidence rates of postoperative complications and major complications are approximately 47% and 12% (9).…”

Section: Introductionmentioning

confidence: 99%

Nomograms predicting primary lymph node metastases and prognosis for synchronous colorectal liver metastasis with simultaneous resection of colorectal cancer and liver metastases

et al. 2021

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Background: It is necessary to identify valuable predictors of primary lymph node metastasis and prognosis for patients with synchronous colorectal cancer liver metastases (CRLM) with simultaneous resection of colorectal cancer (CRC) and liver metastases. This study constructed nomograms especially incorporating preoperative testing markers to predict primary lymph node metastases and prognosis in CRLM patients.Methods: By the highest Youden index (sensitivity + 1-specificity), the optimal cut-off values of testing markers for postoperative major complications and lymph node metastasis were identified. Multivariate regression analysis was used to reveal independent predictors for primary lymph node metastasis, postoperative major complications and progression-free survival (PFS). Nomograms based on independent predictors were constructed, and the discrimination and calibration were evaluated. Results: A nomogram predicting primary lymph node metastasis was based on four risky independent predictors: American Society of Anesthesiologists (ASA) score 3-4, preoperative albumin (ALB) <41.15 g/L, poor differentiation and multiple liver metastases. The performance of the model was acceptable in predicting lymph node metastasis, with an area under the receiver operating characteristic curve (AUROC) of 0.655 (95% CI: 0.591-0.739). Calibration curves and the Hosmer-Lemeshow test revealed desirable model calibration (chi-square: 13.26, P=0.815). In the multivariate analysis, preoperative lactate dehydrogenase (LDH) ≥202.5 U/L [odds ratio (OR) =2.084, 95% confidence interval (CI): 1.039-4.181, P=0.039] and operation time ≥350.5 min (OR =2.848, 95% CI: 1.418-5.723, P=0.003) were independently associated with the presence of postoperative major complications. A nomogram predicting PFS was constructed based on poor differentiation, positive lymph node metastasis, bilobar liver distribution and R0 resection with good discrimination (C-index: 0.656±0.021) and calibration.Conclusions: This study established predictive nomograms specifically incorporating preoperative ALB and LDH levels for the prediction of primary lymph node metastasis and prognosis in synchronous CRLM patients with simultaneous resection, which have favourable discrimination and calibration to make individualized predictions.

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Section: Introductionmentioning

confidence: 99%

Nomograms predicting primary lymph node metastases and prognosis for synchronous colorectal liver metastasis with simultaneous resection of colorectal cancer and liver metastases

et al. 2021

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“…Also, there is no significant difference between the two surgical strategies regarding short-term and long-term outcomes (10,11,20,21). Our experiences from the clinical practice at our center attest to safety and efficacy of treating CRLM patients using simultaneous surgical resection (13,14). Moreover, the ideal surgical procedure and incision approach for the simultaneous resection of CRLM, in which various types of incisions have been applied, is still controversial.…”

Section: Discussionmentioning

confidence: 86%

“…Currently, surgical resection remains the best treatment option for colorectal liver metastases (CRLM) (4), with markedly improved overall survival and long-term outcomes (5)(6)(7). Although the vast majority of patients with colorectal cancer and liver metastases have unresectable disease (8,9), with the development of surgical techniques and the use of laparoscopy, there is an increasing number of studies supporting the simultaneous resection of colorectal cancer and liver metastasis as feasible and safe (10)(11)(12)(13)(14)(15). Nevertheless, the surgical procedure of a simultaneous resection could still be improved, for example, the incision type.…”

Section: Introductionmentioning

confidence: 99%

The safety and feasibility of a single incision in simultaneous resection for patients with colorectal cancer liver metastases

et al. 2019

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Background: The approach of performing a simultaneous resection for patients with colorectal cancer liver metastases has been lauded universally, but the operation procedures have differences. In general, colorectal lesions are removed laparoscopically; however, some liver metastases cannot be resected under laparoscopy. For these patients, the traditional approach of performing a simultaneous resection which utilizes the inferior abdominal midline incision and the right subcostal incision is preferred. In this study, we assessed the safety and feasibility of the single right subcostal incision approach for patients with either rectal or sigmoid colon cancer and liver metastasis who underwent simultaneous resection.Methods: A total of 85 patients with rectal or sigmoid colon cancer and liver metastases who underwent simultaneous resection from January 2012 to December 2016 in the Cancer Hospital Chinese Academy of Medical Sciences were identified. Clinicopathological data, as well as operative and perioperative outcomes, were collected and analyzed retrospectively.Results: Overall, 42 patients were included in this study, 26 (61.9%) patients underwent simultaneous resection with a single surgical incision (right subcostal incision), and 16 (38.1%) underwent simultaneous resection with dual surgical incisions (inferior abdominal midline incision and right subcostal incision). Compared to the dual-incision approach, the single-incision approach had a shorter operation time (328.0 vs. 420.0 min, P=0.006) but had no significant differences in total hospitalization time, postoperative hospitalization time, intraoperative blood loss, time of postoperative drainage tube extraction, time to the first postoperative bowel movement, and postoperative complications (P>0.05). Conclusions:The single-incision approach (right subcostal incision) is feasible and safe for patients with either sigmoid colon or rectal cancer and liver metastases.

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“…Delayed resection often compromises overall survival (27). Moreover, Zhang et al (28) and Silberhumer et al ( 29) also concluded that simultaneous surgical resection is a safe and effective treatment option for patients with CRC LM. Compared with staged surgery, there was no significant difference in the longterm prognosis of patients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study

et al. 2022

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ImportanceCurrently, surgical resection of distant metastatic lesions has become the preferred treatment for select colorectal cancer (CRC) patients with liver metastasis (LM) and/or pulmonary metastasis (PM). Metastasectomy is the most common curative method. However, evidence of the factors affecting the prognosis of CRC patients after resection of LM and/or PM is still insufficient.ObjectiveTo explore the prognostic factors of CRC patients with LM and/or PM who have undergone resection of metastatic tumors and to provide reliable selection factors for surgical treatment in patients affected by LM and/or PM from CRC.MethodsThe SEER database was used to identify eligible CRC LM and/or PM patients who underwent resection of the primary tumor and distant metastases from January 1, 2010, to December 31, 2018. The Kaplan–Meier method was used to calculate survival, and comparisons were performed using the log-rank test for univariate analysis. A Cox proportional hazards regression model was used to identify prognostic factors for the multivariate analysis. The outcomes included overall survival (OS) and cancer-specific survival (CSS).ResultsA total of 3,003 eligible colorectal cancer patients with LM and/or PM were included in this study. The 3-year and 5-year OS rates were 53% and 33.6%, respectively, and the 3-year and 5-year CSS rates were 54.2% and 35.3%, respectively. In the adjusted multivariate analysis, age < 65 years (OS: p=0.002, CSS: p=0.002) was associated with better long-term outcomes, and primary tumors located on the left side of the colon (OS: p=0.004, CSS: p=0.006) or rectum (OS: p=0.004, CSS: p=0.006), T3 stage (OS: p<0.001, CSS: p<0.001), number of regional lymph nodes examined ≥ 12 (OS: p<0.001, CSS: p=0.001), and CRC LM (OS: p<0.001, CSS: p<0.001) were positive prognostic factors for survival after resection of metastatic tumors.ConclusionAge < 65 years is associated with better long-term outcomes in colorectal cancer patients with LM and/or PM, analogously to the left sided primary tumor, T3 stage, number of regional lymph nodes examined ≥ 12 and liver metastases.

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Prognostic Analysis of 102 Patients with Synchronous Colorectal Cancer and Liver Metastases Treated with Simultaneous Resection

Cited by 7 publications

References 13 publications

Nomograms predicting primary lymph node metastases and prognosis for synchronous colorectal liver metastasis with simultaneous resection of colorectal cancer and liver metastases

Nomograms predicting primary lymph node metastases and prognosis for synchronous colorectal liver metastasis with simultaneous resection of colorectal cancer and liver metastases

The safety and feasibility of a single incision in simultaneous resection for patients with colorectal cancer liver metastases

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study

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