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Prognostic impact of conversion hepatectomy for initially unresectable colorectal liver metastasis

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Abstract

Purpose

This study aimed to evaluate the prognostic impact of conversion hepatectomy in patients with initially unresectable colorectal liver metastasis (CRLM) and to identify prognostic factors after conversion hepatectomy.

Methods

Correlations of conversion hepatectomy with relapse-free survival (RFS) and overall survival (OS) were retrospectively investigated in 554 consecutive patients who underwent hepatectomy for CRLM in 2000–2017. Prognostic factors after conversion hepatectomy were examined in multivariable analysis.

Results

Five hundred and nine patients (92%) had initially resectable CRLM at diagnosis and underwent hepatectomy (primary resection group) and 45 (8%) underwent conversion hepatectomy following chemotherapy (conversion group). The 5-year RFS was 30.0% in the primary resection group and 19.8% in the conversion group (p = 0.042); the respective 5-year OS rates were 62.0% and 52.4% (p = 0.253). Multivariable analysis did not identify conversion hepatectomy as a significant prognostic factor for RFS (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.64–1.37, p = 0.796) or OS (HR 1.12, 95% CI 0.67–1.79, p = 0.667). In the conversion group, multivariable analysis identified the following independent prognostic factors: timing of liver metastases for RFS (synchronous: HR 3.14, 95% CI 1.20–8.24, p = 0.020) and preoperative CEA level for RFS (> 5 ng/ml: HR 3.10, 95% CI 1.45–6.61, p = 0.003) and OS (> 5 ng/ml: HR 3.29, 95% CI 1.18–9.17, p = 0.023).

Conclusions

RFS and OS rates after conversion hepatectomy were not inferior to those after primary resection in patients with CRLM. Patients with a normal CEA level before hepatectomy can be expected to have good long-term prognosis after conversion hepatectomy.

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Acknowledgements

The authors thank M. Moriya, Y. Kishi, T. Akasu, S. Fujita, S. Yamamoto, T. Hamaguchi, H. Ochiai, R. Sakamoto, and S. Dai, all of whom are former staff members in our divisions. The authors also thank all colleagues and nurses involved in patient care.

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yasuyuki Takamizawa, Manabu Inoue, Konosuke Moritani, Shunsuke Tsukamoto & Yukihide Kanemitsu

  2. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Minoru Esaki & Kazuaki Shimada

Authors
  1. Yasuyuki Takamizawa
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  2. Manabu Inoue
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  3. Konosuke Moritani
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  4. Shunsuke Tsukamoto
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  5. Minoru Esaki
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Contributions

Study conception design: Takamizawa, Kanemitsu. Data acquisition: Takamizawa, Inoue, Moritani, Tsukamoto, Esaki, and Shimada, Kanemitsu. Data analysis and interpretation: Takamizawa, Inoue, Moritani, Tsukamoto, Esaki, Shimada, and Kanemitsu. Drafting the article: Takamizawa. Critical revision for intellectual content: Inoue, Moritani, Tsukamoto, Esaki, Shimada, and Kanemitsu. Final approval of the manuscript: Takamizawa, Inoue, Moritani, Tsukamoto, Esaki, Shimada, and Kanemitsu. Agree to be accountable for all aspects of work to ensure that questions regarding accuracy and integrity investigated and resolved: Takamizawa, Inoue, Moritani, Tsukamoto, Esaki, Shimada, and Kanemitsu.

Corresponding author

Correspondence to Yasuyuki Takamizawa.

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The authors declare no competing interests.

Ethics approval

This study was approved by the Institutional Review Board (IRB) of the National Cancer Center Hospital (IRB code: 2017–437).

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The requirement for written informed consent was waived in view of the retrospective nature of the research and the anonymity of the data.

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The authors declare no competing interests.

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Takamizawa, Y., Inoue, M., Moritani, K. et al. Prognostic impact of conversion hepatectomy for initially unresectable colorectal liver metastasis. Langenbecks Arch Surg 407, 2893–2903 (2022). https://doi.org/10.1007/s00423-022-02666-7

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