Annals of Surgical Oncology

, Volume 14, Issue 3, pp 1143–1150

Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Authors

    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
  • Luca Vigano’
    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
  • Alessandro Ferrero
    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
  • Roberto Lo Tesoriere
    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
  • Dario Ribero
    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
  • Roberto Polastri
    • Unit of Surgical OncologyInstitute for Cancer Research and Treatment
Article

DOI: 10.1245/s10434-006-9284-5

Cite this article as:
Capussotti, L., Vigano’, L., Ferrero, A. et al. Ann Surg Oncol (2007) 14: 1143. doi:10.1245/s10434-006-9284-5

Abstract

Background

Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy.

Methods

The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).

Results

Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064)

Conclusions

Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.

Keywords

Liver surgeryColorectal liver metastasesSynchronous liver metastasesTiming of liver resectionNeoadjuvant chemotherapyPrognostic factors

Copyright information

© Society of Surgical Oncology 2007