The Influence of Intraoperative Hypotension and Perioperative Blood Transfusion on Disease-free Survival in Patients with Complete Resection of Golorectal Liver Metastases

Abstract

An increased interest in surgical treatment of liver metastases from colorectal origin has evolved recently. However not all patients benefit from this approach, with early recurrence and death still being encountered. To evaluate clinical as well as perioperative factors that might significantly affect the outcome of patients with completely resected colorectal liver metastases, we examined 116 patients who underwent resection between September 1987 and August 1989. Median follow-up time was 13.2 months (0.6 to 31.4 months). The overall survival rate was 91% at 1 year and 75% at 2 years. Median survival was not reached. Median disease-free survival time was 11.5 months, with 49.4% and 21.2% of the patients being free of disease at 1 and 2 years, respectively. By univariate analysis, site of primary colorectal cancer, preoperative carcinoembryonic antigen (CEA) level, size of metastases, number of metastases, length of operation time, percentage mean arterial pressure, number of hypotensive episodes, duration of hypotensive episodes, and whole blood transfusion significantly affected recurrence rate following resection. However only site of primary tumor, CEA, number of metastases, and number of hypotensive episodes remained significant in the multivariate analysis. The most significant single factor that affected recurrence rate was the number of hypotensive episodes during the operative procedure. It is concluded that hypotensive episodes, even when well controlled, should be avoided during operation to maximize the chances of cure and prolong disease-free survival of patients with colorectal liver metastases.

Prognostic Factors for Survival after Resection of Liver Metastases from Colorectal Cancer: A Single Institution Analysis of 655 Cases

“…Currently, it is universally accepted that liver resection is associated with the highest survival rates (3,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Even in the present study the 10-year OS rate was 17.1%, similar to those already reported in the literature (10,14).…”

Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal

“…Apesar dos dados controversos e conflitantes em relação a esse fator prognóstico e a todos os outros, há consenso na literatura (3,12,23,26,29,33,36,39,41,45) : não há contra-indicação para a ressecção de metástase com tamanho maior do que 5 cm.…”

“…Resultados diferentes foram relatados por JAECK et al (22) , CADY et al (8) e AMBIRU et al (3) , que não consideraram o intervalo de tempo entre a ressecção do tumor primário e o surgimento da metástase hepática como fatores prognósticos independentes. Apesar dos resultados discordantes a respeito da importância desse fator, há consenso na literatura (3,12,23,26,28,29,36,39,41,45) de que o intervalo entre a ressecção do tumor primário e o surgimento da metástase no fígado não contra-indica a ressecção hepática.…”

“…Resultados semelhantes foram observados por SUGAWARA et al (41) , em 304 pacientes, e por LISE et al (26) , em 135 pacientes. Alguns estudos têm demonstrado que o nível pré-operatório de CEA com pontos de corte variando entre 20 e 200 ng/mL é fator prognóstico independente (7,13,14,22,30,35,45) . Apesar de não haver unanimidade quanto a esse ser fator prognóstico independente, há consenso na literatura de que o nível pré-operatório de CEA, qualquer que seja, não contra-indica a ressecção hepática de metástases colorretais.…”

Follow-up after Colorectal Cancer Surgery

“…The intrahepatic tumour number as an exclusion criterion for liver surgery is still a matter of debate. Several investigators regard three tumours as an upper limit when liver resection is to be performed (61,62,64,66), while in other studies the tumour number has not been found to be a significant prognostic factor (59,60,63,65,67). It is estimated that 10 Á/20% of all patients with colorectal liver metastases are candidates for liver surgery (76).…”