HEPATECTOMY FOR COLORECTAL CANCER METASTASIS HOW TO DEFINE CURE AND WHICH FACTORS CAN PREDICT LONG TERM OUTCOMES?

Introduction: Colorectal cancer represents the third most frequent neoplasm worldwide and hepatic metastasis are pointed as the major cause of death due to this disease, being surgical resection the only potential curative treatment. Overall 5-year and 10-year survival rates up to 50% and 25% respectively have been described in literature, but a great variability in factors predicting these results is also found. Objectives: In this study we aimed to analyze prognostic factors associated with long-term outcomes (5-year actual survival rates) in a Brazilian population treated with curative intent for colorectal liver metastases. Methodology: Retrospective analysis of medical charts of all patients who underwent resection of colorectal liver metastasis at Abdominal Surgery Department at A. C. Camargo Cancer Center, from 2000 to 2012. Patients with previous liver resection and lack of information in medical charts were excluded. Statistical analysis were performed using SPSS, and a Cox regression model was performed to determine prognostic factor associated with long term outcomes. Results: We included 280 patients. The median age was 59 years (23-84 years), 56.1% (n=157) of them were male and 77.5% were classified as ASA 2. The median number of resected hepatic nodules was 2 (1-20 nodules) and the median size of the largest nodule was 3.5 cm. Almost half of the cases (48.6%) had bilobar disease and 17.5% had the diagnosis of extrahepatic disease prior hepatectomy. After a median follow-up period of 108 months, 5-year overall survival was 51.5% and disease-free survival was 30.6%, median overall survival was 61.17 months. Multivariable analysis identified bilobar disease (p<0.001), extra-hepatic disease prior to hepatectomy (p<0.001) and major postoperative complications (p=0.005) as independent predictors for overall survival. The ones associated with disease-free survival were extra-hepatic disease prior to hepatectomy (p=0.001), number of resected nodules (p=0.001) and bilobar disease (p=0.002). Of the 84 patients who were free of disease at a complete 5-year follow-up, only 7 patients (8,4%) experienced relapse, and no recurrence could be detected after 10-year follow-up period. Conclusions: Hepatic resection in association with multimodal treatment has led to long-term survival in patients with colorectal liver metastases. The prognostic factors associated with better survival should be used in patient selection for radical treatment.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019