Results of Surgery and Prognostic Factors

  • Dario Ribero


Hepatic resection is the treatment of choice for colorectal liver metastases, with 5-year survival rates now approaching 60%. Postoperative morbidity and mortality are constantly decreasing. In particular, 90-day postoperative mortality has been reported in several series to be less than 1%. Several prognostic factors of poor outcome have been recognized but, at present, most of them cannot be used to select patients for resection. Future identification of molecular factors may aid in the prediction of prognosis and help to improve the selection of those patients most likely to benefit from surgery.


Liver Metastasis Liver Resection Hepatic Resection Metastatic Colorectal Cancer Colorectal Liver Metastasis 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Simmonds PC, Primrose J N, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: A systematic review of published studies. Br J Cancer 94:982–999CrossRefPubMedGoogle Scholar
  2. 2.
    Scheele J, Stang R, Altendorf-Hofmann A, Paul M (1995). Resection of colorectal liver metastases. World J Surg 19:59–71CrossRefPubMedGoogle Scholar
  3. 3.
    Nordlinger B, Guiguet M, Vaillant JC et al (1996) 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 77:1254–1262Google Scholar
  4. 4.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318CrossRefPubMedGoogle Scholar
  5. 5.
    Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–99CrossRefPubMedGoogle Scholar
  6. 6.
    Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766CrossRefPubMedGoogle Scholar
  7. 7.
    Ercolani G, Grazi GL, Ravaioli M et al (2002) Liver resection for multiple colorectal metastases. Influence of parenchymal involvement and total tumor volume, vs number or location, on long-term survival. Arch Surg 137:1187–1192CrossRefPubMedGoogle Scholar
  8. 8.
    Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy. A model to predict long-term survival. Ann Surg 240: 644–658CrossRefPubMedGoogle Scholar
  9. 9.
    Fernandez FG, Drebin JA, Linehan DC et al (2004) 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 240:438–447CrossRefPubMedGoogle Scholar
  10. 10.
    Jonas S, Thelen A, Benckert C et al (2007) Extended resections of liver metastases from colorectal cancer. World J Surg 31:511–521CrossRefPubMedGoogle Scholar
  11. 11.
    Malik HZ, Prasad R, Halazun KJ et al (2007) Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg 246:806–814CrossRefPubMedGoogle Scholar
  12. 12.
    Tomlinson JS, Jarnagin WR, DeMatteo RP et al (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580CrossRefPubMedGoogle Scholar
  13. 13.
    Are C, Gonen M, Zazzali K et al (2007) The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg 246:295–300CrossRefPubMedGoogle Scholar
  14. 14.
    Rees M, Tekkis PP, Welsh FKS et al (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer. A multifactorial model of 929 patients. Ann Surg 247: 125–135CrossRefPubMedGoogle Scholar
  15. 15.
    Gold JS, Are C, Kornprat P et al (2008) 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 247:109–117CrossRefPubMedGoogle Scholar
  16. 16.
    House MG, Ito H, Gönen M et al (2010) 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 210:744–754CrossRefPubMedGoogle Scholar
  17. 17.
    Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825CrossRefPubMedGoogle Scholar
  18. 18.
    Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–724CrossRefPubMedGoogle Scholar
  19. 19.
    Viganò L, Ferrero A, Lo Tesoriere R et al (2008) 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 15:2458–2464CrossRefPubMedGoogle Scholar
  20. 20.
    de Jong MC, Pulitano C, Ribero D et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis. An international multi-institutional analysis of 1669 patients. Ann Surg 250:440–448PubMedGoogle Scholar
  21. 21.
    Mullen JT, Ribero D, Reddy S et al (2007) Hepatic insufficiency and mortality in 1059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–864CrossRefPubMedGoogle Scholar
  22. 22.
    Capussotti L, Viganò L, Giuliante F et al (2009) Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg 96:88–94CrossRefPubMedGoogle Scholar
  23. 23.
    Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection. Analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–407CrossRefPubMedGoogle Scholar
  24. 24.
    Scheele J, Altendorf-Hofmann A (1999) Resection of colorectal liver metastases. Langenbeck’s Arch Surg 384:313–327CrossRefGoogle Scholar
  25. 25.
    Fortner JG, Silva JS, Golbey RB et al (1984) Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg 199:306–316CrossRefPubMedGoogle Scholar
  26. 26.
    Ohlsson B, Stenram U, Tranberg KG (1998) Resection of colorectal metastases: 25-year experience. World J Surg 22:268–276CrossRefPubMedGoogle Scholar
  27. 27.
    Cady B, Jenkins RL, Steele GD Jr et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 227:566–571CrossRefPubMedGoogle Scholar
  28. 28.
    Ambiru S, Miyazaki M, Isono T et al (1999) Hepatic resection for colorectal metastases. Analysis of prognostic factors. Dis Colon Rectum 42:632–639CrossRefPubMedGoogle Scholar
  29. 29.
    Iwatsuki S, Dvorchik I, Madariaga JR et al (1999) Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 189:291–299CrossRefPubMedGoogle Scholar
  30. 30.
    Ueno H, Mochizuki H, Hatsuse K et al (2000) Indicators for treatment strategies of colorectal liver metastases. Ann Surg 231:59–66CrossRefPubMedGoogle Scholar
  31. 31.
    Lise M, Bacchetti S, Da Pian P et al (2001) Patterns of recurrence after resection of colorectal liver metastases: prediction by models of outcome analysis. World J Surg 25:638–644CrossRefPubMedGoogle Scholar
  32. 32.
    Nagashima I, Takada T, Matsuda K et al (2004) A new scoring system to classify patients with colorectal liver metastases: proposal of criteria to select candidates for hepatic resection. J Hepatobiliary Pancreat Surg 11:79–83CrossRefPubMedGoogle Scholar
  33. 33.
    Schindl M, Wigmore SJ, Currie EJ et al (2005) Prognostic scoring in colorectal cancer liver metastases. Development and validation. Arch Surg 140:183–189CrossRefPubMedGoogle Scholar
  34. 34.
    Wei AC, Greig PD, Grant D et al (2006) Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol 13:668–676CrossRefPubMedGoogle Scholar
  35. 35.
    Zakaria S, Donohue JH, Que F G, et al (2007) Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg 246:183–191CrossRefPubMedGoogle Scholar
  36. 36.
    Kishi Y, Kopetz S, Chun YS et al (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16:614–622CrossRefPubMedGoogle Scholar
  37. 37.
    Aloia TA, Vauthey JN, Loyer EM et al (2007) Solitary colorectal liver metastasis. Resection determines outcome. Arch Surg 141:460–467Google Scholar
  38. 38.
    Hamady ZZ, Malik HZ, Finch R et al (2006) Hepatic resection for colorectal metastasis: impact of tumour size. Ann Surg Oncol 13:1493–1439CrossRefPubMedGoogle Scholar
  39. 39.
    Kokudo N, Imamura H, Sugawara Y et al (2004) Surgery for multiple hepatic colorectal metastases. J Hepatobiliary Pancreat Surg 11:84–91CrossRefPubMedGoogle Scholar
  40. 40.
    Pawlik TM, Abdalla EK, Ellis LM et al (2006) Debunking dogma: surgery for four or more colorectal liver metastases is justified. J Gastrointest Surg 10:240–248CrossRefPubMedGoogle Scholar
  41. 41.
    Tanaka K, Adam R, Shimada H et al (2003) Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 90: 963–969CrossRefPubMedGoogle Scholar
  42. 42.
    Smith MD McCall JL (2009) Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg 96:1101–1113CrossRefPubMedGoogle Scholar
  43. 43.
    Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869CrossRefPubMedGoogle Scholar
  44. 44.
    Okano T, Ohwada S, Nakasone Y et al (2001) Blood transfusion causes deterioration in liver regeneration after partial hepatectomy in rats. J Surg Res 101:157–165CrossRefPubMedGoogle Scholar
  45. 45.
    Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–870CrossRefPubMedGoogle Scholar
  46. 46.
    Farid SG, Aldouri A, Morris-Stiff G et al (2010) Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg 251:91–100CrossRefPubMedGoogle Scholar
  47. 47.
    Reissfelder C, Rahbari NN, Koch M et al (2009) Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases. Ann Surg Oncol 16:3279–3288CrossRefPubMedGoogle Scholar
  48. 48.
    Kattan MW, Gonen M, Jarnagin WR et al (2008) A nomogram for predicting disease-specific survival after hepatic resection for metastatic colorectal cancer. Ann Surg 247:282–287CrossRefPubMedGoogle Scholar
  49. 49.
    Adam R, Pascal G, Castaing D et al (2004) Tumor progression while on chemotherapy. A contraindication to liver resection for multiple colorectal metastases? Ann Surg 240:1052–1064CrossRefPubMedGoogle Scholar
  50. 50.
    Gruenberger B, Scheithauer W, Punzengruber R et al (2008) Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases. BMC Cancer 8:120CrossRefPubMedGoogle Scholar
  51. 51.
    Saltz LB, Clarke S, Diaz-Rubio E et al (2008) Bevacizumab in combination with oxaliplatinbased chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 26:2013–2019CrossRefPubMedGoogle Scholar
  52. 52.
    Chun YS, Vauthey JN, Boonsirikamchai P et al. (2009) Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA 302:2338–2344CrossRefPubMedGoogle Scholar
  53. 53.
    Rubbia-Brandt L, Giostra E, Brezault C et al (2007) Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol 18:299–304CrossRefPubMedGoogle Scholar
  54. 54.
    Blazer DG III, Kishi Y, Maru DM et al (2008) Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases. J Clin Oncol 26:5344–5351CrossRefPubMedGoogle Scholar
  55. 55.
    DeOliveira ML, Pawlik TM, Gleisner AL et al (2007) Echogenic appearance of colorectal liver metastases on intraoperative ultrasonography is associated with survival after hepatic resection. J Gastrointest Surg 11:970–976CrossRefPubMedGoogle Scholar
  56. 56.
    Canna K, McArdle PA, McMillan DC et al (2005) The relationship between tumor T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer 92:651–654CrossRefPubMedGoogle Scholar
  57. 57.
    Okano K, Maeba T, Modoguchi A et al (2003) Lymphocytic infiltration surrounding liver metastases from colorectal cancer. J Surg Oncol 82:28–33CrossRefPubMedGoogle Scholar
  58. 58.
    Neal CP, Garcea G, Doucas H et al (2006) Molecular prognostic markers in resectable colorectal liver metastases: a systematic review. Eur J Cancer 42:1728–1743CrossRefPubMedGoogle Scholar
  59. 59.
    Domont J, Pawlik TM, Boige V et al (2005) Catalytic subunit of human telomerase reverse transcriptase is an independent predictor of survival in patients undergoing curative resection of hepatic colorectal metastases: a multicenter analysis. J Clin Oncol 23:3086–3093CrossRefPubMedGoogle Scholar
  60. 60.
    Pantel K, von Knebel Doeberitz M (2000) Detection and clinical relevance of micrometastatic cancer cells. Curr Opin Oncol 12:95–101CrossRefPubMedGoogle Scholar
  61. 61.
    Liotta LA, Stetler-Stevenson WG (1991) Tumor invasion and metastasis: an imbalance of positive and negative regulation. Cancer Res 51(suppl 18): 5054–5059Google Scholar
  62. 62.
    Koch M, Kienle P, Hinz U et al (2005) Detection of hematogenous tumor cell dissemination predicts tumor relapse in patients undergoing surgical resection of colorectal liver metastases. Ann Surg 241:199–205CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Dario Ribero
    • 1
  1. 1.Division of Hepato-Bilio-Pancreatic and Digestive SurgeryMauriziano “Umberto I” HospitalTurinItaly

Personalised recommendations