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Treatment strategy for resectable colorectal cancer liver metastases from the viewpoint of time to surgical failure

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Abstract

Purpose

The efficacy of pre or postoperative chemotherapy for resectable colorectal cancer liver metastases (CRLM) is disputed. This study aimed to examine the risk factors for time to surgical failure (TSF) and analyze the efficacy of pre or postoperative chemotherapy prior to liver resection for CRLM.

Methods

The clinicopathological factors of 567 patients who underwent initial hepatectomy for CRLM at 7 university hospitals between April 2007 and March 2013 were retrospectively analyzed. The prognostic factors were identified and then stratified into two groups according to the number of preoperative prognostic factors: the high-score group (H-group, score 2–4) and the low-score group (L-group, score 0 or 1).

Results

Patients who experienced unresectable recurrence within 12 months after initial treatment had a significantly shorter prognosis than other patients (p < 0.001). Multivariate analysis identified age ≥ 70 (p = 0.001), pT4 (p = 0.015), pN1 (p < 0.001), carbohydrate antigen 19–9 ≥ 37 U/ml (p = 0.002), Clavien-Dindo grade ≥ IIIa (p = 0.013), and postoperative chemotherapy (p = 0.006) as independent prognostic factors. In the H-group, patients who received chemotherapy had a better prognosis than those who did not (p = 0.001).

Conclusion

Postoperative chemotherapy is beneficial in colorectal cancer patients with more than two of the following factors: age ≥ 70, carbohydrate antigen 19–9–positivity, pT4, and lymph node metastasis.

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Data availability

Reasonable requests for access to the data may be directed to the corresponding author.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan

    Fumitoshi Hirokawa, Koji Komeda & Kazuhisa Uchiyama

  2. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Masaki Ueno & Shinya Hayami

  3. Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Japan

    Takuya Nakai

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Masaki Kaibori & Hisashi Kosaka

  5. Department of Surgery, Nara Medical University, Kashihara, Japan

    Takeo Nomi & Daisuke Hokuto

  6. Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Hiroya Iida

  7. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Shogo Tanaka & Shoji Kubo

Authors
  1. Fumitoshi Hirokawa
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  2. Masaki Ueno
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Corresponding author

Correspondence to Fumitoshi Hirokawa.

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The study and the associated protocol received approval from the Ethics Committee of each institution (approval number: 2734, Osaka Medical College). We have obtained consent to participate.

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Hirokawa, F., Ueno, M., Nakai, T. et al. Treatment strategy for resectable colorectal cancer liver metastases from the viewpoint of time to surgical failure. Langenbecks Arch Surg 407, 699–706 (2022). https://doi.org/10.1007/s00423-021-02372-w

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  • DOI: https://doi.org/10.1007/s00423-021-02372-w

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