Advertisement

Annals of Surgical Oncology

, Volume 19, Issue 6, pp 2035–2044 | Cite as

Evolution of Long-Term Outcome of Liver Resection for Colorectal Metastases: Analysis of Actual 5-Year Survival Rates over Two Decades

  • Luca Viganò
  • Nadia Russolillo
  • Alessandro Ferrero
  • Serena Langella
  • Elisa Sperti
  • Lorenzo Capussotti
Hepatobiliary Tumors

Abstract

Background

Liver resection (LR) is the only potentially curative treatment of colorectal liver metastases (CRLM). Its outcome over the past 2 decades was studied using actual 5-year survival rates.

Methods

Data of 393 consecutive patients who underwent LR for CRLM at Mauriziano Umberto I (Turin) until June 2005 were analyzed. Excluding R2 resections (n = 4) or incomplete 5-year follow-up (n = 13), 376 patients were divided according to LR date into groups A (before 1995: 90 patients), B (1995–2000: 94 patients), C (2001–2005: 192).

Results

Group C presented increased multiple and bilobar metastases compared with combined group A and B (C vs AB: 54.7% vs 40.2%, P = 0.005; 28.1% vs 19.0%, P = 0.038, respectively), decreased metastases diameter (C vs AB: 32 vs 40 mm, P = 0.0001). The 5-year overall survival, calculated excluding 4 operative mortalities (group AB), increased over the years (A, 20.5%; B, 32.6%; C, 46.4%; P < 0.0001). Early recurrences (1 year) were not decreased, extrahepatic recurrences even increased (C vs AB: 17.2% vs 8.6%, P = 0.015). Recurrence-free 5-year survival improved (C vs AB: 23.4% vs 13.9%, P = 0.019) linked to decreased liver recurrences (C vs AB: 26.8% vs 37.4%, P = 0.023). Resection rate (59% overall for liver recurrence) increased along with 5-year survival after recurrence (A, 4.0%; B, 14.2%; C, 21.4%; P < 0.0001). Survival improvement was confirmed for multiple (P = 0.003) and synchronous metastases (P = 0.008), N+ tumors (P = 0.005), and in patients without chemotherapy (P = 0.001).

Conclusions

Long-term outcome of LR for CRLM improved over 20 years, even in patients with negative prognostic factors, linked to hepatic recurrences reduction and increased survival after recurrence.

Keywords

Liver Resection Negative Prognostic Factor Synchronous Metastasis Liver Recurrence Extrahepatic Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors are extremely grateful to Prof Claire de Burbure for revising the manuscript.

Conflict of interest

None to declare.

References

  1. 1.
    Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg. 1990;77:1241–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Wagner JS, Adson MA, Van Heerden JA, Adson MH, Ilstrup DM. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg. 1984;199:502–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94:982–99.PubMedCrossRefGoogle Scholar
  4. 4.
    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;230:309–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Viganò L, Ferrero A, Lo Tesoriere R, Capussotti L. Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol. 2008;15:2458–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Regge D, Campanella D, Anselmetti GC, Cirillo S, Gallo TM, Muratore A, et al. Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. Clin Radiol. 2006;61:338–47.PubMedCrossRefGoogle Scholar
  8. 8.
    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;240:438–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Tanaka K, Adam R, Shimada H, Azoulay D, Lévi F, Bismuth H. Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg. 2003;90:963–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Parikh AA, Gentner B, Wu TT, Curley SA, Ellis LM, Vauthey JN. Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg. 2003;7:1082–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Capussotti L, Viganò L, Ferrero A, Lo Tesoriere R, Ribero D, Polastri R. Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model. Ann Surg Oncol. 2007;14:1143–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206.PubMedCrossRefGoogle Scholar
  14. 14.
    House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Andres A, Majno PE, Morel P, Rubbia-Brandt L, Giostra E, Gervaz P, et al. Improved long-term outcome of surgery for advanced colorectal liver metastases: reasons and implications for management on the basis of a severity score. Ann Surg Oncol. 2008;15:134–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Portier G, Elias D, Bouche O, Rougier P, Bosset JF, Saric J, et al. Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol. 2006;24:4976–82.PubMedCrossRefGoogle Scholar
  17. 17.
    Mitry E, Fields AL, Bleiberg H, Labianca R, Portier, Tu D, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol. 2008;26:4906–11.PubMedCrossRefGoogle Scholar
  18. 18.
    Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H. Liver resection for colorectal metastases: the third hepatectomy. Ann Surg. 2003;238:871–83.PubMedCrossRefGoogle Scholar
  19. 19.
    de Jong MC, Mayo SC, Pulitano C, Lanella S, Ribero D, Strub J, et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg. 2009;13:2141–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.PubMedCrossRefGoogle Scholar
  22. 22.
    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;235:759–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Capussotti L, Ferrero A, Viganò L, Ribero D, Lo Tesoriere R, Polastri R. Major liver resections synchronous with colorectal surgery. Ann Surg Oncol. 2007;14:195–201.PubMedCrossRefGoogle Scholar
  24. 24.
    Capussotti L, Ferrero A, Viganò L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: Where is the risk? Arch Surg. 2006;141:690–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Capussotti L, Viganò L, Giuliante F, Ferrero A, Giovannini I, Nuzzo G. Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg. 2009;96:88–94.PubMedCrossRefGoogle Scholar
  26. 26.
    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;231:487–99.PubMedCrossRefGoogle Scholar
  27. 27.
    Khatri VP, Petrelli NJ, Belghiti J. Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit? J Clin Oncol. 2005;23:8490–9.PubMedCrossRefGoogle Scholar
  28. 28.
    de Haas RJ, Wicherts DA, Andreani P, Pascal G, Saliba F, Ichai P, et al. Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg. 2011;253:1069–79.PubMedCrossRefGoogle Scholar
  29. 29.
    de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick RD, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250:440–8.PubMedGoogle Scholar
  30. 30.
    Tanaka K, Shimada H, Ueda M, Matsuo K, Endo I, Togo S. Long-term characteristics of 5-year survivors after liver resection for colorectal metastases. Ann Surg Oncol. 2007;14:1336–46.PubMedCrossRefGoogle Scholar
  31. 31.
    D’Angelica M, Brennan MF, Fortner JG, Cohen AM, Blumgart LH, Fong Y. Ninety-six five-year survivors after liver resection for metastatic colorectal cancer. J Am Coll Surg. 1997;185:554–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg. 2006;93:1001–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008;247:109–17.PubMedCrossRefGoogle Scholar
  34. 34.
    Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A, et al. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg. 2006;10:86–94.PubMedCrossRefGoogle Scholar
  35. 35.
    Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, et al. “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg. 2005;201:517–28.PubMedCrossRefGoogle Scholar
  36. 36.
    Ferrero A, Viganò L, Lo Tesoriere R, Russolillo N, Sgotto E, Capussotti L. Bisegmentectomies as alternative to right hepatectomy in the treatment of colorectal liver metastases. Hepatogastroenterology. 2009;56:1429–35.PubMedGoogle Scholar
  37. 37.
    Giuliante F, Ardito F, Pulitanò C, Vellone M, Giovannini I, Aldrighetti L, et al. Does hepatic pedicle clamping affect disease-free survival following liver resection for colorectal metastases? Ann Surg. 2010;252:1020–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237:860–9.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Luca Viganò
    • 1
  • Nadia Russolillo
    • 1
  • Alessandro Ferrero
    • 1
  • Serena Langella
    • 1
  • Elisa Sperti
    • 2
  • Lorenzo Capussotti
    • 1
  1. 1.Department of HPB and Digestive SurgeryOspedale Mauriziano Umberto ITurinItaly
  2. 2.Department of OncologyOspedale Mauriziano Umberto ITurinItaly

Personalised recommendations