Long-Term Results and Prognostic Significance of Non-ANATOMIC Liver Resection for Colorectal Liver Metastasis: Single Center Experience

Abstract

Development of liver metastasis is a single poor prognostic indicator if left untreated, and therefore management of colorectal liver metastasis (CRLM) is a subject of active multidisciplinary approach. We aimed to evaluate the long-term results and poor prognostic indicators in patients undergoing liver resection for CRLM from a single center in Turkey. All patients who underwent hepatic resection due to colorectal metastasis between March 2007 and November 2011 in our institute were included. Demographic data, operative and postoperative parameters, and long-term follow-up data were analyzed. A total of 44 patients [29 (65.9%) male, median age: 61 (32-81) years] were included to the study. Most of the patients [28 (63.6%) had metachronous liver metastasis, and almost half of the patients [19 (45.2%)] was oligometastatic. Major resection was performed in 18 (40.9%) patients. Intraoperative US changed the operative strategy in 7 (19.4%) patients. Thirty-day mortality was observed in 4 (9.1%) patients. Reasons for mortality were uncontrolled sepsis [catheter infection (n = 1), anastomotic leak (n = 1), and intraabdominal abscess (n = 1)] and hepatic insufficiency (n = 1). Follow-up period excluding patients with early mortality was 30.4 (3-138) months. Kaplan-Meier survival analysis revealed that estimated median survival time after hepatic resection was 28 (95% CI: 20.6-35.4) months. Five-year and 10-year survival probabilities were 20.5% and 13.3%, respectively. Multivariate Cox regression analyses showed that surgical margin positivity was the only significant factor affecting survival. Our results suggest that tumor margin and number of metastasis are the two determinant prognostic indicators in patients with CRLM. Surgery seems to offer a chance for cure, and surgeons in the field should try to perform liver resections in order to obtain negative margins. Major hepatic resections are justified provided that patient selection and preparation is thorough and surgical procedure can be performed safely.