Langenbeck's Archives of Surgery

, Volume 389, Issue 5, pp 371–379 | Cite as

Pre-hepatectomy prognostic staging to determine treatment strategy for colorectal cancer metastases to the liver

  • Kuniya Tanaka
  • Hiroshi Shimada
  • Yoshirou Fujii
  • Itaru Endo
  • Hitoshi Sekido
  • Shinji Togo
  • Hideyuki Ike
Original Article



Attempts at identifying prognostic factors after hepatectomy in patients with colorectal liver metastases have not achieved consensus. We investigated prognostic factors ascertainable before hepatectomy for colorectal metastasis.


Clinicopathological data for 149 consecutive patients with colorectal cancer who underwent curative resection of primary lesions and metastatic liver disease at one institution were subjected to multivariate analysis concerning metastatic status and the primary lesion.


Poorly differentiated adenocarcinoma or mucinous carcinoma as the primary tumor (Poor/muc; P=0.026), marked vascular invasion by the primary tumor (V; P=0.002), bi-lobar liver metastases (P=0.048), and short doubling time (DT) of the liver tumor (P=0.028) were characteristics assessable before hepatectomy that independently indicated poorer survival. A four-stage classification based on these factors was related to overall (P<0.01) and disease-free (P<0.01) survival rates. No pattern of recurrence site was evident in stage I (patients with no risk factor). Recurrence was usually extrahepatic in stage IV (patients with Poor/muc) but favored the remnant liver in stage II (patients with bi-lobar metastases or short DT) or III (patients with V; P=0.037). Stage III showed more multiple and early hepatic recurrences than stage II, and repeat hepatectomy was less frequent (P<0.05).


Pre-hepatectomy prognostic staging should help to guide treatment of liver metastases.


Colorectal cancer Liver metastasis Hepatectomy Prognostic factor Staging 


  1. 1.
    D’Angelica M, Brennan MF, Fortner JG, Cohen AM, Blumgart LH, Fong Y (1997) Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg 185:554–559CrossRefPubMedGoogle Scholar
  2. 2.
    Fong Y, Fortner JG, Sun R, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321CrossRefPubMedGoogle Scholar
  3. 3.
    Scheele J, Stang R, Altendorf-Hofmann A, Paul M (1995) Resection of colorectal liver metastases. World J Surg 19:59–71PubMedGoogle Scholar
  4. 4.
    Bismuth H, Adam R, Levi F, Farabos C, Waechter F, Castaing D, Majno P, Engerran L (1996) Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–522CrossRefPubMedGoogle Scholar
  5. 5.
    Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785CrossRefPubMedGoogle Scholar
  6. 6.
    Giacchetti S, Itzhaki M, Gruia G, Adam R, Zidani R, Kunstlinger F, Brienza S, Alafaci E, Bertheault-Cvitkovic F, Jasmin C, Reynes M, Bismuth H, Misset JL, Levi F (1999) Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 10:663–669CrossRefPubMedGoogle Scholar
  7. 7.
    Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, Kunstlinger F, Levi F, Bismuth H (2001) Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal (liver) metastases. Ann Surg Oncol 8:347–353CrossRefPubMedGoogle Scholar
  8. 8.
    Malafosse R, Penna C, Sa Cunha A, Nordlinger B (2001) Surgical management of hepatic metastases from colorectal malignancies. Ann Oncol 12:887–894CrossRefPubMedGoogle Scholar
  9. 9.
    Yasui K, Hirai T, Kato T, Torii A, Uesaka K, Morimoto T, Kodera Y, Yamamura Y, Kito T, Hamajima N (1997) A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer. Ann Surg 226:582–586CrossRefPubMedGoogle Scholar
  10. 10.
    Collins VP, Loeffier RK, Tivey H (1956) Observations on growth rates of human tumors. Am J Roentgenol 76:988–1000Google Scholar
  11. 11.
    Staab HJ, Anderer FA, Hornung A, Stumpf E, Fischer R (1982) Doubling time of circulating CEA and its relation to survival of patients with recurrent colorectal cancer. Br J Cancer 46:773–781PubMedGoogle Scholar
  12. 12.
    Havelaar IJ, Sugerbaker PH, Vermes M, Miller DL (1984) Rate of growth of intraabdominal metastases from colorectal cancer. Cancer 54:163–171PubMedGoogle Scholar
  13. 13.
    Fujii S (1994) Hepatic metastases development from colorectal cancer in view of CEA doubling time (in Japanese with English abstract). Yokohama Igaku 45:627–635Google Scholar
  14. 14.
    Shimada H, Nanko M, Fujii S, Masui H, Togo S, Ike H, Nakano A, Ohki S (1995) Treatment strategies for hepatic metastasis from colorectal cancer. J Hepatobiliary Pancreat Surg 2:116–121Google Scholar
  15. 15.
    Japanese Society for Cancer of the Colon and Rectum (1997) Japanese classification of colorectal carcinoma, 1st English edn. Kanehara, TokyoGoogle Scholar
  16. 16.
    Kawasaki S, Makuuchi M, Kakazu T (1994) Resection for multiple metastatic liver tumors after portal embolization. Surgery 115:674–677PubMedGoogle Scholar
  17. 17.
    Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F, Bonalumi MG (1995) Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg 82:377–381PubMedGoogle Scholar
  18. 18.
    Gayowski TJ, Iwatsuki S, Madariage JR, Selby R, Todo S, Irish W, Starzl TE (1994) Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 116:703–711PubMedGoogle Scholar
  19. 19.
    Jatzko GR, Lisborg PH, Stettner HM, Klimpfinger MH (1995) Hepatic resection for metastases from colorectal carcinoma—a survival analysis. Eur J Cancer 31A:41–46CrossRefPubMedGoogle Scholar
  20. 20.
    Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer 77:1254–1262CrossRefPubMedGoogle Scholar
  21. 21.
    Scott S, Carty N, Anderson L, Taylor I (1995) Liver resection for colorectal liver metastases. Eur J Surg Oncol 21:33–35PubMedGoogle Scholar
  22. 22.
    Iwatsuki S, Esquivel CO, Gordon RD, Starzl TE (1986) Liver resection for metastatic colorectal cancer. Surgery 100:804–809PubMedGoogle Scholar
  23. 23.
    Fortner JG (1988) Recurrence of colorectal cancer after hepatic resection. Am J Surg 155:378–382PubMedGoogle Scholar
  24. 24.
    Ekberg H, Tranberg KG, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S (1987) Pattern of recurrence in liver resection for colorectal secondaries. World J Surg 11:541–547PubMedGoogle Scholar
  25. 25.
    Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F (1991) One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 78:797–801PubMedGoogle Scholar
  26. 26.
    Bozzetti F, Bignami P, Montalto F, Doci R, Gennari L (1992) Repeat hepatic resection for recurrent metastases from colorectal cancer. Br J Surg 79:146–148PubMedGoogle Scholar
  27. 27.
    Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T (2000) Indication for treatment strategies of colorectal liver metastases. Ann Surg 231:59–66CrossRefPubMedGoogle Scholar
  28. 28.
    Minagawa Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer. Ann Surg 231:487–499CrossRefPubMedGoogle Scholar
  29. 29.
    Deans GT, Patterson CC, Parks TG, Spence RA, Heatley M, Moorehead RJ, Rowlands BJ (1994) Colorectal carcinoma: importance of clinical and pathological factors in survival. Ann R Coll Surg Engl 76:59–64Google Scholar
  30. 30.
    Goslin R, Steele G, Zamcheck N, Mayer R, Macintyre J (1982) Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum. Dis Colon Rectum 25:749–754PubMedGoogle Scholar
  31. 31.
    Savage AP, Malt RA (1992) Survival after hepatic resection for malignant tumours. Br J Surg 79:1095–1101PubMedGoogle Scholar
  32. 32.
    Kato T, Yasui K, Hirai T, Kanemitsu Y, Mori T, Sugihara K, Mochizuki H, Yamamoto J (2003) Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy: analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum 46 [10 Suppl]:S22–31PubMedGoogle Scholar
  33. 33.
    Yamada H, Kondo S, Okushiba S, Morikawa T, Katoh H (2001) Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases. World J Surg 25:1129–1133PubMedGoogle Scholar
  34. 34.
    Koga H, Moriya Y, Akasu T, Fujita S (1999) The relationship between prognosis and CEA-dt after hepatic resection in patients with colorectal carcinomas. Eur J Surg Oncol 25:292–296CrossRefPubMedGoogle Scholar
  35. 35.
    Bismuth H, Castaing D, Traynor O (1988) Surgery for synchronous hepatic metastases of colorectal cancer. Scand J Gastroenterol 149:144–149Google Scholar
  36. 36.
    Griiffith KD, Sugarbaker PH, Chang AE (1990) Repeat hepatic resection for colorectal metastases. Surgery 81:101–104Google Scholar
  37. 37.
    Panis Y, Ribeiro J, Chretien Y, Nordlinger B (1994) Dormant liver metastases: an experimental study. Br J Surg 19:221–233Google Scholar
  38. 38.
    Slooter GD, Marquet RJ, Jeekel J, Ijzermans JNM (1995) Tumor growth stimulation after partial hepatectomy can be reduced by treatment with tumor necrosis factor alpha. Br J Surg 82:129–132PubMedGoogle Scholar
  39. 39.
    Picardo A, Karpoff HM, Ng B, Lee J, Brennan MF, Fong Y (1998) Partial hepatectomy accelerates local tumor growth: potential roles of local cytokine activation. Surgery 124:57–64CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Kuniya Tanaka
    • 1
  • Hiroshi Shimada
    • 1
  • Yoshirou Fujii
    • 1
  • Itaru Endo
    • 1
  • Hitoshi Sekido
    • 1
  • Shinji Togo
    • 1
  • Hideyuki Ike
    • 1
  1. 1.Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan

Personalised recommendations