Journal of Gastrointestinal Surgery

, Volume 12, Issue 6, pp 1054–1060 | Cite as

Perioperative Morbidity Affects Long-Term Survival in Patients Following Liver Resection for Colorectal Metastases

  • M. Schiesser
  • J. W. C. Chen
  • G. J. Maddern
  • R. T. A. Padbury
original article



Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases.


One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction, and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an objective surgical complication classification.


The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%. The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative complications was 3.2 years, compared to 4.4 years in those patients without complications (p < 0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients with a margin (p = 0.019).


Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following liver resection for colorectal metastases.


Perioperative complications Colorectal metastases Liver resection Prognostic factors Hepatectomy 



We would like to thank Kylie Lange, statistical consultant from Flinders University, for the statistical advice and thorough review of the data and Lisa Leopardi for the assistance in the data management.


  1. 1.
    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(3):309–318; discussion 318–321.PubMedCrossRefGoogle Scholar
  2. 2.
    Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996;77(7):1254–1262.PubMedCrossRefGoogle Scholar
  3. 3.
    Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, et al. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 1992;216(4):493–504; discussion 504–505.PubMedCrossRefGoogle Scholar
  4. 4.
    Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995;19(1):59–71.PubMedCrossRefGoogle Scholar
  5. 5.
    Jenkins LT, Millikan KW, Bines SD, Staren ED, Doolas A. Hepatic resection for metastatic colorectal cancer. Am Surg 1997;63(7):605–610.PubMedGoogle Scholar
  6. 6.
    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(6):759–766.PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004;240(3):438–447; discussion 447–450.PubMedCrossRefGoogle Scholar
  8. 8.
    Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P, et al. Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie. Br J Surg 1997;84(7):977–980.PubMedCrossRefGoogle Scholar
  9. 9.
    Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M, et al. Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 2001;181(2):153–159.PubMedCrossRefGoogle Scholar
  10. 10.
    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(4):566–571.PubMedCrossRefGoogle Scholar
  11. 11.
    Elias D, Cavalcanti A, Sabourin JC, Pignon JP, Ducreux M, Lasser P. Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases. J Surg Oncol 1998;69(2):88–93.PubMedCrossRefGoogle Scholar
  12. 12.
    Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 2000;231(4):487–499.PubMedCrossRefGoogle Scholar
  13. 13.
    Laurent C, Sa Cunha A, Couderc P, Rullier E, Saric J. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 2003;90(9):1131–1136.PubMedCrossRefGoogle Scholar
  14. 14.
    Fujita S, Teramoto T, Watanabe M, Kodaira S, Kitajima M. Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol 1993;23(5):299–302.PubMedGoogle Scholar
  15. 15.
    Hirai T, Yamashita Y, Mukaida H, Kuwahara M, Inoue H, Toge T. Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today 1998;28(6):576–579.PubMedCrossRefGoogle Scholar
  16. 16.
    Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 2006;10(10):1338–1345; discussion 1345–1346.PubMedCrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–213.PubMedCrossRefGoogle Scholar
  18. 18.
    IHPBA TCot. Terminology of liver anatomy and resections. HPB Surg 2000;2:333–339.Google Scholar
  19. 19.
    Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003;238(5):703–710.PubMedCrossRefGoogle Scholar
  20. 20.
    Nagano Y, Tanaka K, Togo S, Matsuo K, Kunisaki C, Sugita M, et al. Efficacy of hepatic resection for hepatocellular carcinomas larger than 10 cm. World J Surg 2005;29(1):66–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg 2000;87(11):1553–1562.PubMedCrossRefGoogle Scholar
  22. 22.
    Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD. Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 1994;220(2):109–120.PubMedCrossRefGoogle Scholar
  23. 23.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244(6):931–937; discussion 937–939.PubMedCrossRefGoogle Scholar
  24. 24.
    Martin RC 2nd, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Ann Surg 2002;235(6):803–813.PubMedCrossRefGoogle Scholar
  25. 25.
    Panis Y, Ribeiro J, Chretien Y, Nordlinger B. Dormant liver metastases: An experimental study. Br J Surg 1992;79(3):221–223.PubMedCrossRefGoogle Scholar
  26. 26.
    Morise Z, Sugioka A, Fujita J, Hoshimoto S, Kato T, Hasumi A, et al. Does repeated surgery improve the prognosis of colorectal liver metastases? J Gastrointest Surg 2006;10(1):6–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Petrowsky H, Gonen M, Jarnagin W, Lorenz M, DeMatteo R, Heinrich S, et al. Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: A bi-institutional analysis. Ann Surg 2002;235(6):863–871.PubMedCrossRefGoogle Scholar
  28. 28.
    Nagano Y, Nojiri K, Matsuo K, Tanaka K, Togo S, Ike H, et al. The impact of advanced age on hepatic resection of colorectal liver metastases. J Am Coll Surg 2005;201(4):511–516.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • M. Schiesser
    • 1
  • J. W. C. Chen
    • 2
  • G. J. Maddern
    • 3
  • R. T. A. Padbury
    • 2
    • 4
  1. 1.Department of Visceral and Transplantation SurgeryUniversity Hospital of ZurichZurichSwitzerland
  2. 2.Department of SurgeryFlinders Medical CentreAdelaideAustralia
  3. 3.Department of SurgeryQueen Elizabeth HospitalAdelaideAustralia
  4. 4.Surgical and Specialty ServicesFlinders Medical CentreSouth AustraliaAustralia

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