Survival after hepatic resection of colorectal cancer metastases

Abstract

BACKGROUND: Most estimates of short‐ and long‐term survival after hepatic resection of colorectal cancer metastases are derived from surgical case series. For the current report, the authors used Medicare data to investigate operative mortality and long‐term survival in a national sample and examined the factors associated with survival. METHODS: Data were analyzed from Medicare enrollees (age ≥65 years) who were admitted to hospital between January 1, 2000 and December 31, 2004 with a primary diagnosis of colorectal cancer with resection. The sample was restricted to patients who subsequently underwent hepatic resection for liver metastases. The Medicare Denominator File was used to determine operative mortality and long‐term survival and the factors that were associated with those outcomes. RESULTS: Of the 306,061 Medicare beneficiaries who were diagnosed with colorectal cancer, 3957 patients were identified who underwent hepatic resection for liver metastases. The crude 30‐day and 90‐day mortality rates were 4% and 8.2%, respectively, and the 5‐year survival rate was 25.5%. Advancing age (hazards ratio [HR], 1.83; 95% confidence interval [95% CI], 1.32‐2.53 for age ≥80 years vs ages 65‐69 years), comorbid disease (HR, 1.40; 95% CI, 1.06‐1.85 for Charlson ≥5 vs Charlson 0), and synchronous colon/hepatic resection (HR, 2.46; 95% CI, 1.89‐3.20 for synchronous vs metachronous resection) were associated with worse 90‐day mortality. Similarly, long‐term mortality was associated with age (HR, 1.36; 95% CI, 1.18‐1.56), comorbid disease (HR, 1.51; 95% CI, 1.36‐1.69), and synchronous colon/hepatic resection (HR, 1.37; 95% CI, 1.24‐1.51 for synchronous vs metachronous resection). CONCLUSIONS: In this national study, short‐ and long‐term survival was worse than that reported in surgical case series. Subgroups at high risk for worse outcomes include the extreme elderly and those undergoing synchronous colon and hepatic resection. Cancer 2009. © 2009 American Cancer Society.

Validation of the peak bilirubin criterion for outcome after partial hepatectomy

“…14 However, this is a rather short period of time since the majority of complications occur within 90 days after liver resection. 16 The peak bilirubin criterion is one of the main predictors used in daily practice, 17 but modern practice has changed in the last decade. With the increasing incidence of non-alcoholic fatty liver disease, extending indications for resection, 18 and complex vascular procedures, 19 postoperative morbidity and mortality are negatively affected.…”

A single institute retrospective trial of concurrent chemotherapy with SIR-Spheres® versus SIR-Spheres® alone in chemotherapy-resistant colorectal cancer liver metastases

“…Moreover, twothirds of CRC deaths are due to liver metastases (2). Liver resection significantly prolongs overall survival in patients with colorectal liver metastases (CRLM), however, only 20% of CRLM patients are eligible for liver resection (3)(4)(5) and more than 50% experience hepatic recurrence (2). Patients with unresectable CRLM are candidates for a variety of liver directed therapies to improve hepatic disease control, and ultimately delay hepatic failure (6).…”

Stereotactic Body Radiation Therapy for Patients with Heavily Pretreated Liver Metastases and Liver Tumors

“…The treatment of liver metastases and primary liver tumors has evolved with surgery as the current standard of care for localized lesions in medically operable patients (Robertson et al, 2009). Some patients with extensive liver metastasis at presentation can become surgical candidates following chemotherapy, as improved drugs with better response rates have been developed (Adam et al, 2009).…”