Prognostic Factors in Primary and Iterative Surgery of Colorectal Liver Metastases

Purpose For patients with colorectal liver metastases (CLM), regional lymph node (RLN) involvement is one of the worst prognostic factors. The objective of this study was to evaluate the ability of a multidisciplinary approach, including preoperative chemotherapy and hepatectomy, to improve patient outcomes. Patients and Methods Outcomes for a consecutively treated group of patients with CLM and simultaneous RLN involvement were compared with a cohort of patients without RLN involvement. Univariate and multivariate analysis of clinical variables was used to identify prognostic factors in this high-risk group. Results Of the 763 patients who underwent resection at our institution for CLM between 1992 and 2006, 47 patients (6%) were treated with hepatectomy and simultaneous lymphadenectomy. All patients had received preoperative chemotherapy. Five-year overall survival (OS) for patients with and without RLN involvement were 18% and 53%, respectively (P < .001). Five-year disease-free survival rates were 11% and 23%, respectively (P = .004). When diagnosed preoperatively, RLN involvement had an increased 5-year OS compared with intraoperative detection, although the difference was not significant (35% v 10%; P = .18). Location of metastatic RLN strongly influenced survival, with observed 5-year OS of 25% for pedicular, 0% for celiac, and 0% for para-aortic RLN (P = .001). At multivariate analysis, celiac RLN involvement and age ≥ 40 years were identified as independent poor prognostic factors. Conclusion Combined liver resection and pedicular lymphadenectomy is justified when RLN metastases respond to or are stabilized by preoperative chemotherapy, particularly in young patients. In contrast, this approach does not benefit patients with celiac and/or para-aortic RLN involvement, even when patients’ disease is responding to preoperative chemotherapy.

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Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

Macedonian Medical Review ◽

10.1515/mmr-2016-0025 ◽

2016 ◽

Vol 70 (3) ◽

pp. 133-139

Author(s):

Stefan Petrovski ◽

Elena Arabadzhieva ◽

Saso Bonev ◽

Dimitar Bulanov ◽

Valentin Popov ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Prognostic Significance ◽

Radical Resection ◽

University Hospital ◽

Tumor Type ◽

Term Survival ◽

Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

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Prognostic factors after resection of colorectal liver metastases following preoperative second-line chemotherapy: Impact of RAS mutations

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.02.249 ◽

2016 ◽

Vol 42 (9) ◽

pp. 1378-1384 ◽

Cited By ~ 6

Author(s):

G. Passot ◽

Y.S. Chun ◽

S.E. Kopetz ◽

M.J. Overman ◽

C. Conrad ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Second Line ◽

Ras Mutations ◽

Second Line Chemotherapy ◽

Line Chemotherapy

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Survival and Prognostic Factors of Colorectal Liver Metastases After Surgical and Nonsurgical Treatment

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2016.04.007 ◽

2016 ◽

Vol 15 (4) ◽

pp. e183-e192 ◽

Cited By ~ 6

Author(s):

Johannes Lemke ◽

Gregor Cammerer ◽

Johannes Ganser ◽

Jan Scheele ◽

Pengfei Xu ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Nonsurgical Treatment

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Surgical Management of Liver Metastases From Colorectal Cancer

Journal of Oncology Practice ◽

10.1200/jop.2015.009407 ◽

2016 ◽

Vol 12 (1) ◽

pp. 33-39 ◽

Cited By ~ 18

Author(s):

Mashaal Dhir ◽

Aaron R. Sasson

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Liver Metastases ◽

Surgical Resection ◽

Surgical Management ◽

Colorectal Liver Metastases ◽

Multidisciplinary Approach ◽

Treatment Options ◽

Optimal Timing ◽

Medical Oncologists

Surgical resection remains one of the major curative treatment options available to patients with colorectal liver metastases. Surgery and chemotherapy form the backbone of the treatment in patients with colorectal liver metastases. With more effective chemotherapy regimens being available, the optimal timing and sequencing of treatments are important. A multidisciplinary approach with the involvement of medical oncologists and surgical oncologists from the beginning is crucial. Identification of the clinical and molecular prognostic factors may help personalize the treatment approaches for these patients. This article provides an overview of the surgical management of colorectal liver metastases.

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Prognostic factors after ultrasound-guided percutaneous ablation of colorectal liver metastases: A systematic review

Australasian Journal of Ultrasound in Medicine ◽

10.1002/ajum.12088 ◽

2018 ◽

Vol 21 (2) ◽

pp. 87-95

Author(s):

Jeanett Klubien ◽

Andreas P. Kohl ◽

Christian P. Nolsøe ◽

Jacob Rosenberg ◽

Hans-Christian Pommergaard

Keyword(s):

Systematic Review ◽

Prognostic Factors ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Percutaneous Ablation ◽

Ultrasound Guided

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Actual 10-Year Survival After Resection of Colorectal Liver Metastases Defines Cure

Journal of Clinical Oncology ◽

10.1200/jco.2007.11.0833 ◽

2007 ◽

Vol 25 (29) ◽

pp. 4575-4580 ◽

Cited By ~ 708

Author(s):

James S. Tomlinson ◽

William R. Jarnagin ◽

Ronald P. DeMatteo ◽

Yuman Fong ◽

Peter Kornprat ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Randomized Clinical Trials ◽

Curative Intent ◽

Term Survival ◽

Number Of Patients ◽

Disease Free ◽

Disease Specific

Purpose Resection of colorectal liver metastases (CLM) in selected patients has evolved as the standard of care during the last 20 years. In the absence of prospective randomized clinical trials, a survival benefit has been deduced relative to historical controls based on actuarial data. There is now sufficient follow-up on a significant number of patients to address the curative intent of resecting CLM. Methods Retrospective review of a prospectively maintained database was performed on patients who underwent resection of CLM from 1985 to 1994. Postoperative deaths were excluded. Disease-specific survival (DSS) was calculated from the time of hepatectomy using the Kaplan-Meier method. Results There were 612 consecutive patients identified with 10-year follow-up. Median DSS was 44 months. There were 102 actual 10-year survivors. Ninety-nine (97%) of the 102 were disease free at last follow-up. Only one patient experienced a disease-specific death after 10 years of survival. In contrast, 34% of the 5-year survivors suffered a cancer-related death. Previously identified poor prognostic factors found among the 102 actual 10-year survivors included 7% synchronous disease, 36% disease-free interval less than 12 months, 25% bilobar metastases, 50% node-positive primary, 39% more than one metastasis, and 35% tumor size more than 5 cm. Conclusion Patients who survive 10 years appear to be cured of their disease, whereas approximately one third of actual 5-year survivors succumb to a cancer-related death. In well-selected patients, there is at least a one in six chance of cure after hepatectomy for CLM. The presence of poor prognostic factors does not preclude the possibility of long-term survival and cure.

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