Clinical features and prognosis in hepatectomy for colorectal cancer with centrally located liver metastasis

World Journal of Surgical Oncology

Ming-Chin Yu²  Jinn-Shiun Chen¹  Kun-Ming Chan²  Chien-Yuh Yeh¹  Jy-Ming Chiang¹  Song-Fong Huang²  I-Ming Kuo² 

[1] Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan;Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan

关键词: Prognosis;    Centrally located;    Hepatectomy;    Liver metastasis;    Colorectal cancer;   

Others  :  1137179
DOI  :  10.1186/s12957-015-0497-6

 received in 2014-09-17, accepted in 2015-02-01,  发布年份 2015

【 摘 要 】

Background

Hepatic metastasectomy for patients with primary colorectal cancer offers better long-term outcome, and chemotherapy can increase the rate of hepatic resectability for patients with initially inoperable disease. The pattern of liver metastasis and status of the primary tumor are rarely discussed in the analysis of long-term outcome. In this report, we evaluate the influence of the pattern of metastasis on clinical features and prognosis.

Methods

One hundred and fifty-nine patients who underwent hepatic metastasectomy with curative intent for liver metastasis of colorectal cancer between October 1991 and December 2006 were enrolled. Patients were grouped according to whether liver metastasis was centrally or peripherally located, based on imaging and operative findings. Patient demographics, characteristics of the primary and metastatic tumors, and surgical outcomes were analyzed for long-term survival.

Results

A greater proportion of patients with centrally located metastases were male, as compared with those with peripherally located metastases. Compared with patients with peripherally located metastases, patients with centrally located metastases were more likely to have multiple lesions (P = 0.016), involvement of multiple segments (P = 0.006), large metastases (P < 0.001), and bilobar distribution of metastases (P < 0.001). The estimated 5-year recurrence-free and overall survival rates were 22.4% and 34.2%, respectively. Univariate analysis revealed that centrally located metastasis, primary tumor in the transverse colon, metastasis in regional lymph nodes, initial extrahepatic metastasis, synchronous liver metastasis, multiple lesions, poorly differentiated tumor, and resection margin <10 mm were significant poor prognostic factors for recurrence-free survival and overall survival. Cox regression analysis showed that inadequate resection margin and centrally located liver metastasis were significant predictors of shorter overall survival.

Conclusions

In colorectal cancer, centrally located liver metastasis represents a poor prognostic factor after hepatectomy, and is associated with early recurrence. Neoadjuvant chemotherapy may be used to downstage centrally located liver metastases to improve outcome.

【 授权许可】

   
2015 Kuo et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Geoghegan JG, Scheele J: Treatment of colorectal metastases. Br J Surg 1999, 86:158-69.
• [2]Welch JP, Donaldson GA: The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 1979, 189:496-502.
• [3]Faivre J, Manfredi S, Bouvier AM: Epidemiology of colorectal liver metastases. Bull Acad Natl Med 2003, 187:815-22.
• [4]Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al.: Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002, 235:759-66.
• [5]Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, et al.: Repeat hepatectomy for colorectal liver metastases. Ann Surg 1997, 225:51-60.
• [6]Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al.: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004, 239:818-25.
• [7]Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H: Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 2003, 238:871-84.
• [8]Adam R, Miller R, Pitombo M, Wicherts DA, de Haas RJ, Bitsakou G, et al.: Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases. Surg Oncol Clin N Am 2007, 16:525-36.
• [9]Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, et al.: Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 2008, 248:994-1005.
• [10]Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, et al.: Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal [liver] metastases. Ann Surg Oncol 2001, 8:347-53.
• [11]Tanaka K, Adam R, Shimada H, Azoulay D, Lévi F, Bismuth H: Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 2003, 90:963-9.
• [12]Adam R, Lucidi V, Bismuth H: Hepatic colorectal metastases: methods of improving resectability. Surg Clin North Am 2004, 84:659-71.
• [13]Wicherts DA, de Haas RJ, Adam R: Bringing unresectable liver disease to resection with curative intent. Eur J Surg Oncol 2007, 33:S42-51.
• [14]Vibert E, Canedo L, Adam R: Strategies to treat primary unresectable colorectal liver metastases. Semin Oncol 2005, 32(suppl 8):S33-9.
• [15]Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG: Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 2008, 247:125-35.
• [16]Ueno H, Mochizuki H, Hashiguchi Y, Hatsuse K, Fujimoto H, Hase K: Predictors of extrahepatic recurrence after resection of colorectal liver metastases. Br J Surg 2004, 91:327-33.
• [17]Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999, 230:309-18.
• [18]Shirabe K, Takenaka K, Gion T, Fujiwara Y, Shimada M, Yanaga K, et al.: Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to surgical margin. Br J Surg 1997, 84:1077-80.
• [19]Cady B, Jenkins RL, Steele GD Jr, Lewis WD, Stone MD, McDermott WV, et al.: Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 1998, 227:566-71.
• [20]Ambiru S, Miyazaki M, Isono T, Ito H, Nakagawa K, Shimizu H, et al.: Hepatic resection for colorectal metastasis: analysis of prognostic factors. Dis Colon Rectum 1999, 42:632-9.
• [21]Luu C, Arrington AK, Schoellhammer HF, Singh G, Kim J: Targeted therapies in colorectal cancer: surgical considerations. J Gastrointest Oncol 2013, 4:328-36.
• [22]de Haas RJ, Wicherts DA, Flores E, Azoulay D, Castaing D, Adam R: R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 2008, 248:626-37.
• [23]Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al.: Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004, 240:644-58.
• [24]Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y: Preoperative determination of the surgical procedure for hepatectomy using technetium99m-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy. Hepatology 1997, 25:426-9.
• [25]Takasaki K, Kobayashi S, Tanaka S, Muto H, Watayo T, Saito A, et al.: Newly developed systematized hepatectomy by Glissonean pedicle transection method. Shujutsu 1986, 40:7-14.
• [26]Inoue Y, Hayashi M, Komeda K, Masubuchi S, Yamamoto M, Yamana H, et al.: Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer. J Gastrointest Surg 2012, 16:1171-80.
• [27]Yasui K, Hirai T, Kato T, Morimoto T, Torii A, Uesaka K, et al.: Major anatomical hepatic resection with regional lymph node dissection for liver metastases from colorectal cancer. J Hep Bil Pancr Surg 1995, 2:103-7.
• [28]DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y: Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 2000, 4:178-84.
• [29]Hamady ZZ, Kotru A, Nishio H, Lodge JP: Current techniques and results of liver resection for colorectal liver metastases. Br Med Bull 2004, 70:87-104.
• [30]Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T: Indicators for treatment strategies of colorectal liver metastases. Ann Surg 2000, 231:59-66.
• [31]Tsai MS, Su YH, Ho MC, Liang JT, Chen TP, Lai HS, et al.: Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol 2006, 14:786-94.
• [32]Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, et al.: The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg 2007, 246:295-300.
• [33]Sugihara K, Hojo K, Moriya Y, Yamasaki S, Kosuge T, Takayama T: Pattern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993, 80:1032-5.
• [34]Scheele J, Altendorf-Hofmann A: Resection of colorectal liver metastases. Langenbecks Arch Surg 1999, 84:313-27.
• [35]Harmon KE, Ryan JA Jr, Biehl TR, Lee FT: Benefits and safety of hepatic resection for colorectal metastases. Am J Surg 1999, 177:402-4.
• [36]Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM: Resection of hepatic metastases from colorectal cancer. Arch Surg 1984, 119:647-51.
• [37]Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, et al.: Liver resection for colorectal metastases. J Clin Oncol 1997, 15:938-46.
• [38]Hughes KS, Rosenstein RB, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, et al.: Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum 1988, 31:1-4.
• [39]Mekenkamp LJ, Koopman M, Teerenstra S, van Krieken JH, Mol L, Nagtegaal ID, et al.: Clinicopathological features and outcome in advanced colorectal cancer patients with synchronous vs metachronous metastases. Br J Cancer 2010, 103:159-64.
• [40]Nakajima K, Takahashi S, Saito N, Kotaka M, Konishi M, Gotohda N, et al.: Predictive factors for anastomotic leakage after simultaneous resection of synchronous colorectal liver metastasis. J Gastrointest Surg 2012, 16:821-7.
• [41]Hansen IO, Jess P: Possible better long-term survival in left versus right-sided colon cancer - a systematic review. Dan Med J 2012, 59:A4444.
• [42]Giacchetti S, Itzhaki M, Gruia G, Adam R, Zidani R, Kunstlinger F, et al.: Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 1999, 10:663-9.
• [43]Wolpin BM, Meyerhardt JA, Mamon HJ, Mayer RJ: Adjuvant treatment of colorectal cancer. CA Cancer J Clin 2007, 57:168-85.
• [44]Tomimaru Y, Sasaki Y, Yamada T, Gotoh K, Noura S, Eguchi H, et al.: Liver metastasis originating from colorectal cancer with macroscopic portal vein tumor thrombosis: a case report and review of the literature. J Med Case Rep 2010, 4:382-6. BioMed Central Full Text
• [45]Pfannschmidt J, Dienemann H, Hoffmann H: Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 2007, 84:324-38.
• [46]Pastorino U, Buyse M, Friedel G, Ginsberg RJ, Girard P, Goldstraw P, et al.: Long-term results of lung metastasectomy: prognostic analyses based on 5206. J Thorac Cardiovasc Surg 1997, 113:37-49.
• [47]Kim AW, Faber LP, Warren WH, Saclarides TJ, Carhill AA, Basu S, et al.: Repeat pulmonary resection for metachronous colorectal carcinoma is beneficial. Surgery 2008, 144:712-8.
• [48]Adam R, de Haas RJ, Wicherts DA, Aloia TA, Delvart V, Azoulay D, et al.: Is hepatic resection justified after chemotherapy in patients with colorectal liver metastases and lymph node involvement? J Clin Oncol 2008, 26:3672-80.