Surgical Experience with Hepatic Colorectal Metastasis

Abstract

The outcome of 134 patients undergoing hepatic resection for colorectal metastasis was studied. Current follow-up was available in 98 per cent of patients, for more than 5 years in 58 patients, and totaling 360 patient-years. Patients (52% male) had an average age of 62 ± 1 years (standard error of the mean). Time lapse between the primary colon surgery and hepatic resection was a median of 16 months and a mean of 19 ± 1 months. Thirty-two (24%) were operated on within 6 months for both their primary tumor and hepatic metastasis. Intensive care unit and total hospital length of stay were a median of 1 and 7 days, respectively. Pathology reports demonstrated that on average there were 2.0 ± 0.1 lesions, with the largest lesion measuring 4.4 ± 0.2 cm. In 72 per cent of patients, the lesions were found in one lobe only. CEA was elevated in 83 per cent of patients preoperatively and was 60 ± 11 ng/mL before and 4.0 ± 0.5 ng/mL after hepatic resection. Patient survival was 81 per cent at 1 year, 50 per cent at 3 years, 36 per cent at 5 years, and 23 per cent at 10 years. Actual 5- and 10-year survival was 22 of 58 (38%) patients and 4 of 21 (19%) patients respectively. Disease-free survival was 58 per cent at 1 year, 27 per cent at 3 years, 16 per cent at 5 years, and 12 per cent at 7 years. Survival was much better for one to four lesions than for five or more lesions (P < 0.01). Several other potential risk factors did not affect survival, including whether the patient received chemotherapy after hepatic resection. There were 36 (43%) patients who recurred with hepatic involvement only, 27 (32%) including hepatic involvement and 21 (25%) with nonhepatic involvement only. There were 15 patients who went on to receive repeat hepatic resections, with a 5-year survival of 74 per cent and disease-free survival of 58 per cent. Hepatic resection provides the best outcome of any form of therapy for selected patients with isolated hepatic metastasis.

Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases

“…Surgical treatment for liver metastases from colorectal cancer is safe and potentially curative, with a 5-year survival rate of 25% to 40% [1][2][3]. After resection, however, it is estimated that the disease recurs in 60% to 85% of the patients; and in approximately 40% of these cases, the disease recurs in the form of isolated liver metastases [7][8][9][10]. The predictive factors for recur-rence following first resection of liver metastases have not yet been clarified.…”

Molecular aspects of tumor cell migration and invasion

“…these data suggest a possible correlation between metastasis and drug resistance mediated by P-gp [117]. an in vivo study conducted by Bradley et al [118] showed that different stages of tumor progression displayed different levels of P-gp m-rNa expression. Surprisingly, 460 lung metastases were examined and each metastasis was positive for P-gp.…”

Outcomes After Hepatic and Pulmonary Metastasectomies Compared With Pulmonary Metastasectomy Alone in Patients With Colorectal Cancer Metastasis to Liver and Lungs

“…Surgical resection is the most effective treatment for colorectal cancer that has metastasized to the liver. This treatment is widely accepted and has produced 5-year survival rates of 25-58 % [6][7][8][9][10]. Lung metastases were previously thought to be incurable and were treated primarily with systemic chemotherapy.…”