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Resection of hepatic metastases from colorectal cancer

Resektion von Lebermetastasen kolorektaler Karzinome

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Summary

Background: The aim of this paper is to analyze our experience with liver resection for metastatic colorectal cancer and to evaluate the prognostic significance of various parameters.

Methods: 40 consecutive patients treated with potentially curative liver resection between 1984 and 1996 were included. The prognostic significance of various parameters was evaluated with respect to survival. Univariate and multivariate analyses were performed for following factors: age, gender, site and stage and grading of the primary tumor, size of metastases, number of metastases, lobar distribution of metastases, diagnostic interval, type of liver resection, resection margin, perioperative blood transfusion and preoperative carcinoembryonic antigen (CEA) level.

Results: 3-year- and 5-year survival was 54% and 33%, median survival was 37 months. The 30 day mortality rate was 0%, postoperative complications occurred in 8 patients (20%). As single factors the following significantly affected the prognosis: number of metastases (p=0.0001), mesenteric lymphnode involvement of the primary tumor (p=0.002), lobar distribution (p=0.002) and intraoperative units of blood (p=0.05).

Multivariate analysis revealed that age, gender, mesenteric lymphnode involvement, number of metastases and synchronous versus metachronous metastatic disease were independent predictors of survival.

Conclusions: Liver resection is effective in selected patients with hepatic metastases from colorectal cancer. In resectable patients it is not possible to establish a clear prognosis based on the investigated factors. Therefore, patients with adverse prognostic factors should not be denied resection.

Zusammenfassung

Grundlagen: Das Ziel dieser Studie war unsere Ergebnisse von Leberresektionen bei metastasierenden kolorektalen Karzinomen zu analysieren. Der Einfluß verschiedener Faktoren auf das Überleben wurde bestimmt und diskutiert.

Methodik: 40 Patienten mit radikalen Resektionen von synchronen oder metachronen Lebermetastasen wurden in die Studie eingeschlossen. Folgende Faktoren wurden in einer univariaten und multivariaten Analyse hinsichtlich ihrer Bedeutung auf das Überleben untersucht: Alter, Geschlecht, Lokalisation, Stadium und Grading des Primärtumors, Größe der Metastasen, Anzahl der Metastasen, Lappenverteilung der Metastasen, Zeitpunkt des Auftretens der Metastasen, Art der Leberresektion, Resektionsrand, Blutkonserven, und präoperativer CEA-Spiegel.

Ergebnisse: Das 3-Jahres- und 5-Jahres-Überleben war 54% und 33%, das mediane Überleben betrug 37 Monate. Die perioperative Mortalität (30 Tage) betrug 0%, Komplikationen traten bei 8 Patienten (20%) auf. In der univariaten Analyse waren die Anzahl der Metastasen (0.0001), N-Stadium des Primärtumors (0.002), Lappenverteilung der Metastasen (0.002) und die Gabe von Blutkonserven (0.05) unabhängige prognostische Faktoren bezüglich des Überlebens.

In der multivariaten Analyse erwiesen sich Alter, Geschlecht, N-Stadium des Primärtumors, Anzahl der Metastasen und Zeitpunkt des Auftretens der Metastasen als unabhängige prognostische Faktoren.

Schlußfolgerungen: Die Resektion kolorektaler Lebermetastasen ist eine wirksame und sichere Form der Therapie bei einem selektionierten Patientengut. Bei Patienten mit resektablen Lebermetastasen erlauben präoperativ erhobene Befunde keine klare Aussage hinsichtlich der Prognose. Es sollte daher das Vorhandensein prognostisch ungünstiger Faktoren nicht als absolute Kontraindikation für eine Resektion gelten. Alle Patienten mit offensichtlich radikal resektablen Lebermetastasen kolorektaler Karzinome sollten als Kandidaten für eine Operation angesehen werden.

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References

  1. Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM: Resection of hepatic metastases from colorectal cancer. Arch Surg 1984;119:647–651.

    PubMed  CAS  Google Scholar 

  2. Adson MA: Resection of liver metastases — when is it worthwhile? World J Surg 1987;11:511–520.

    Article  PubMed  CAS  Google Scholar 

  3. Attiyeh FF, Wanebo HJ, Stearns MW: Hepatic resection for metastasis from colorectal cancer. Dis Colon Rectum 1978;21:160–162.

    Article  PubMed  CAS  Google Scholar 

  4. August DA, Sugarbaker PH, Ottow RT, et al: Hepatic resection of colorectal metastases. Ann Surg 1985;201:210–218.

    Article  PubMed  CAS  Google Scholar 

  5. Bozzetti F, Bignami P, Montalto F, Doci R, Gennari L: Repeated hepatic resection for recurrent metastases from colorectal cancer. Br J Surg 1992;79:146–148.

    Article  PubMed  CAS  Google Scholar 

  6. Butler J, Attiyeh FF, Daly JM: Hepatic resection for metastases of the colon and rectum. Surg Gynecol Obstet 1986;162:109–113.

    PubMed  CAS  Google Scholar 

  7. Cady B, McDermott WV: Major hepatic resection for metachronous metastases from colon cancer. Ann Surg 1985;201:204–209.

    Article  PubMed  CAS  Google Scholar 

  8. Cady B, Stone MD: The role of surgical resection of liver metastases in colorectal carcinoma. Semin Oncol 1991;18:399–406.

    PubMed  CAS  Google Scholar 

  9. Cady B, Stone MD, McDermott WV, et al: Technical and biological factors in disease-free survival after hepatic resection for colorectal cancer metastases. Arch Surg 1992;127:561–569.

    PubMed  CAS  Google Scholar 

  10. Doci R, Bignami P, Quagliuolo V, et al: Continuous hepatic arterial infusion with 5-fluorodeoxyuridine for treatment of colorectal metastases. Reg Cancer Treat 1990;3:13–18.

    Google Scholar 

  11. Doci R, Gennari L, Bignami P, Montalto F, Morabito A, Bozzetti F: One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 1991;78:797–801.

    Article  PubMed  CAS  Google Scholar 

  12. Ekberg M, Tranberg KG, Andersson R, et al: Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986;73:727–731.

    Article  PubMed  CAS  Google Scholar 

  13. Ekberg H, Tranberg KG, Anderson R: Pattern of recurrence in liver resection for colorectal secondaries. World J Surg 1987;11:541–547.

    Article  PubMed  CAS  Google Scholar 

  14. Flanagan L, Foster JH: Hepatic resection for metastatic cancer. Am J Surg 1967;113:551–557.

    Article  PubMed  Google Scholar 

  15. Fortner JG, Silva JS, Cox EB, et al: Multivariate analysis of a person series of 247 patients with liver metastases from colorectal cancer. Ann Surg 1984;199:317–323.

    Article  PubMed  CAS  Google Scholar 

  16. Fortner JG, Silva JS, Golbey RB, et al: Multi-variate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg 1984;199:306–316.

    Article  PubMed  CAS  Google Scholar 

  17. Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE: Experience in hepatic resection for metastatic colorectal cancer: Analysis of clinical and pathologic risk factors. Surgery 1994;116:703–711.

    PubMed  CAS  Google Scholar 

  18. Gennari L, Doci R, Bignami P, Bozzetti F: Surgical treatment of hepatic metastases from colorectal cancer. Ann Surg 1986;203:49–54.

    Article  PubMed  CAS  Google Scholar 

  19. Hohenberger P, Schlag P, Schwarz V, et al: Leberresektion bei Patienten mit Metastasen colorectaler Carcinome: Ergebnisse und prognostische Faktoren. Chirurg 1988;59:410–417.

    PubMed  CAS  Google Scholar 

  20. Hohenberger P, Schlag PM, Gerneth T, Herfarth C: Pre-and postoperative carcinoembryonic antigen determinations in hepatic resection for colorectal metastases: predictive value and implications for adjuvant treatment based on multivariate analysis. Ann Surg 1994;219:135–143.

    Article  PubMed  CAS  Google Scholar 

  21. Holm A, Bradley E, Aldrete JS: Hepatic resection of metastases from colorectal carcinoma. Morbidity, mortality and pattern of recurrence. Ann Surg 1989;209:428–434.

    Article  PubMed  CAS  Google Scholar 

  22. Iwatsuki S, Esquivel CO, Gordon RD, Starzl TE: Liver resection for metastatic colorectal cancer. Surgery 1986;100:804–810.

    PubMed  CAS  Google Scholar 

  23. Iwatsuki S, Starzl TE: Personal experience with 411 hepatic resections. Ann Surg 1988;208:421–434.

    Article  PubMed  CAS  Google Scholar 

  24. Levi F, Misset JL, Brienza S, et al: A chronopharmacologic phase II clinical trial with 5-fluorouracil, folinic acid, and oxaliplatin using an ambulatory multichannel programmable pump. Cancer 1992;69:893–900.

    Article  PubMed  CAS  Google Scholar 

  25. Logan SE, Meier SJ, Ramming KP, et al: Hepatic resection of metastatic colorectal carcinoma. A ten-year experience. Arch Surg 1982;117:25–28.

    PubMed  CAS  Google Scholar 

  26. Nagorne, DM: Hepatic resection for metastases from colorectal cancer. Problems in General Surgery 1987;4:83–92.

    Google Scholar 

  27. Nakamura S, Yokoi Y, Suzuki S, et al: Results of extensive surgery for liver metastases in colorectal carcinoma. Br J Surg 1992;79:35–38.

    Article  PubMed  CAS  Google Scholar 

  28. Nordlinger B, Jaeck D, Guiget M, et al: Multicentric retrospective study by the French Surgical Association, in Nordlinger B, Jaeck D (eds): Treatment of Hepatic Metastases of Colorectal Cancer. Paris, Springer, 1992, pp 129–146.

    Google Scholar 

  29. Nordlinger B, Quilichini MA, Parc R, et al: Hepatic resection from colorectal liver metastases. Influence on survival of pre-operative factors and surgery for recurrence. 80 Cases. Ann Surg 1987;2:256–263.

    Article  Google Scholar 

  30. Petrelli NJ, Nambisa RN, Herrera L, Mittelman A: Hepatic resection for isolated metastasis from colorectal carcinoma. Am J Surg 1985;149:205–209.

    Article  PubMed  CAS  Google Scholar 

  31. Rajpal S, Dasmahapatra KS, Ledesma ET, et al: Extensive resection of isolated metastases from carcinoma of the colon and rectum. Surg Gynecol Obstet 1982;155:813–816.

    PubMed  CAS  Google Scholar 

  32. Registry of Hepatic Metastases: Resectionof the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Surgery 1988;103:278–288.

    Google Scholar 

  33. Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA: Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 1992;216:493–505.

    Article  PubMed  CAS  Google Scholar 

  34. Saenz NC, Cady B, McDermott WV jr, et al: Experience with colorectal liver metastatic to the liver. Surg Clin North Am 1989;69:361–370.

    PubMed  CAS  Google Scholar 

  35. Savage AP, Malt RA: Survival after hepatic resection for malignant tumors. Br J Surg 1992;79:1095–1101.

    Article  PubMed  CAS  Google Scholar 

  36. Scheele J, Stangl R, Altendorf-Hofmann A: Hepatic metastases from colorectal carcinoma: Impact of surgical resection on the natural history. Br J Surg 1990;77:1241–1246.

    Article  PubMed  CAS  Google Scholar 

  37. Scheele J, Stangl R, Altendorf-Hofmann A: Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991;110:13–29.

    PubMed  CAS  Google Scholar 

  38. Scheele J, Stangl R, Altendorf-Hofmann A, Paul M: Resection of colorectal liver metastases. World J Surg 1995;19:59–71.

    Article  PubMed  CAS  Google Scholar 

  39. Seifert JK, Junginger T: Resektion von Lebermetastasen kolorektaler Tumoren. Eine uni- und multivariate Analyse von Prognosefaktoren. Langenbecks Arch Chir 1996;381:187–200.

    Article  PubMed  CAS  Google Scholar 

  40. Stangl R, Altendorf-Hofmann A, Charnley RM, et al: Factors influencing the natural history of colorectal liver metastases. Lancet 1994;343:1405–1410.

    Article  PubMed  CAS  Google Scholar 

  41. Stehlin JS, De Ipolyi PD, Greeff PJ, et al: Treatment of cancer of the liver. Ann Surg 1988;208:23–25.

    Article  PubMed  Google Scholar 

  42. Stephenson KR, Steinberg SM, Hughes KS, et al: Perioperative blood transfusion are associated with decreased time to recurrence and decrease survival after resection of colorectal liver metastases. Ann Surg 1988;208:679–687.

    Article  PubMed  CAS  Google Scholar 

  43. Sugihara K, Hojo K, Moriya Y, Yamaski S, Kosuge T, Takayama T: Pattern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993;80:1032–1035.

    Article  PubMed  CAS  Google Scholar 

  44. Thompson HH, Tompkins RK, Longmire WP: Major hepatic resection: a 25-year experience. Ann Surg 1983;197:375–388.

    Article  PubMed  CAS  Google Scholar 

  45. van Ooijen B, Wiggers T, Meijer S, et al: Hepatic resections for colorectal metastases in the Netherlands: a multiinstitutional 10-year study. Cancer 1992;70:28–34.

    Article  PubMed  Google Scholar 

  46. Vogt P, Raab R, Ringe B, et al: Resection of synchronous liver metastases from colorectal cancer. World J Surg 1991;15:62–67.

    Article  PubMed  CAS  Google Scholar 

  47. Wagner JS, Adson MA, van Heerden JA, et al: The natural history of hepatic metastases from colorectal cancer: A comparison with resective treatment. Ann Surg 1984;199:502–508.

    Article  PubMed  CAS  Google Scholar 

  48. Wang JY, Chiang J-M, Jeng L-B, Changchien CR, Chen JS, Hsu KC: Resection of liver metastases from colorectal cancer; are there any truly significant clinical prognosticators? Dis Colon Rectum 1996;39:847–851.

    Article  PubMed  CAS  Google Scholar 

  49. Yamamoto J, Sugihara K, Kosuge T, Takayama T, Shimada K, Yamasaki S, Sakamoto M, Hirohashi S: Pathologic support for limited hepatectomy in the treatment of liver metastases from colorectal cancer. Ann Surg 1995;221:74–78.

    Article  PubMed  CAS  Google Scholar 

  50. Younes RN, Rogatko A, Brennan MF: The influence of intraoperative hypotension and perioperative blood transfusion on disease-free survival in patients with complete resection of colorectal liver metastases. Ann Surg 1991;214:107–113.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Second Department of Surgery, University of Innsbruck, Anichstraße 35, A-6020, Innsbruck

    M. Eberwein, R. Prommegger, M. Oberwalder, A. Unger, A. Klingler, K. Glaser & J. Tschmelitsch M.D.

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  1. M. Eberwein
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  2. R. Prommegger
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  3. M. Oberwalder
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Correspondence to J. Tschmelitsch M.D..

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Eberwein, M., Prommegger, R., Oberwalder, M. et al. Resection of hepatic metastases from colorectal cancer. Acta Chir Austriaca 30, 242–246 (1998). https://doi.org/10.1007/BF02620215

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