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01-01-2013 | Hepatobiliary Tumors

Up-front Hepatic Resection for Metastatic Colorectal Cancer Results in Favorable Long-term Survival

Authors: Sulaiman Nanji, MD, PhD, Sean Cleary, MD, MSc, Paul Ryan, MD, Maha Guindi, MD, Subani Selvarajah, MD, Paul Grieg, MD, Ian McGilvary, MD, PhD, Bryce Taylor, MD, Alice Wei, MD, MSc, Carol-Anne Moulton, MD, PhD, Steven Gallinger, MD, MSc

Published in: Annals of Surgical Oncology | Issue 1/2013

Abstract

Background

Hepatic metastasis from colorectal cancer (CRC) is best managed with a multimodal approach; however, the optimal timing of liver resection in relation to administration of perioperative chemotherapy remains unclear. Our strategy has been to offer up-front liver resection for patients with resectable hepatic metastases, followed by post–liver resection chemotherapy. We report the outcomes of patients based on this surgical approach.

Methods

A retrospective review of all patients undergoing liver resection for CRC metastases over a 5-year period (2002–2007) was performed. Associations between clinicopathologic factors and survival were evaluated by the Cox proportional hazard method.

Results

A total of 320 patients underwent 336 liver resections. Median follow-up was 40 (range 8–80) months. The majority (n = 195, 60.9 %) had metachronous disease, and most patients (n = 286, 85 %) had a major hepatectomy (>3 segments). Thirty-six patients (11 %) received preoperative chemotherapy, predominantly for downstaging unresectable disease. Ninety-day mortality was 2.1 %, and perioperative morbidity occurred in 68 patients (20.2 %). Actual disease-free survival at 3 and 5 years was 46.2 % and 42 %, respectively. Actual overall survival (OS) at 3 and 5 years was 63.7 % and 55 %, respectively. Multivariate analysis identified four factors that were independently associated with differences in OS (hazard ratio; 95 % confidence interval): size of metastasis >6 cm (2.2; 1.3–3.5), positive lymph node status of the primary CRC (N1 (2.0; 1.0–3.8), N2 (2.4; 1.2–4.9)), synchronous disease (2.1; 1.3–3.5), and treatment with chemotherapy after liver resection (0.42; 0.23–0.75).

Conclusions

Up-front surgery for patients with resectable CRC liver metastases, followed by chemotherapy, can lead to favorable OS.

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Title: Up-front Hepatic Resection for Metastatic Colorectal Cancer Results in Favorable Long-term Survival
Authors: Sulaiman Nanji, MD, PhD
Sean Cleary, MD, MSc
Paul Ryan, MD
Maha Guindi, MD
Subani Selvarajah, MD
Paul Grieg, MD
Ian McGilvary, MD, PhD
Bryce Taylor, MD
Alice Wei, MD, MSc
Carol-Anne Moulton, MD, PhD
Steven Gallinger, MD, MSc
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 1/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2424-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Up-front Hepatic Resection for Metastatic Colorectal Cancer Results in Favorable Long-term Survival

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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