Resected colorectal cancer livermetastases : Prognostic study about 110 patients

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Published Dec 25, 2017
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Vol. 95 No. 5 (2017): Issue May 2017

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Zeineb Mzoughi
Achref Djebbi
Ghofrane Talbi
Houcem Smati
Dhouha Bacha
Sana Ben Slama Mallouli
Saadia Bouraoui
Nafa Arfa
Hafedh Mestiri
Lassad Gharbi
Rached Bayar
Mohamed Taher Khalfallah

Abstract

Introduction: The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring.
Objective: The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases.
Methods: This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality.
The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05.
Results: Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival.
Conclusions: colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies

Keywords:

surgery-mtastases-liver-colorectal-cancer

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References

  1. Hallet J, Sa Cunha A, Adam R, Goere D, Bachellier P, Azoulay D, et al. Factors influencing recurrence following initial hepatectomy for colorectal liver metastases. Br J Surg. 2016;103(10):1366-76.
  2. Lemke J, Cammerer G, Ganser J, Scheele J, Xu P, Sander S, et al. Survival and Prognostic Factors of Colorectal Liver Metastases After Surgical and Nonsurgical Treatment. Clin Colorectal Cancer. Sous presse 2016. DOI 10.1016/j.clcc.2016.04.007
  3. Wagner JS, Adson MA, Van Heerden JA, Adson MH, Ilstrup DM. The Natural History of Hepatic Metastases from Colorectal Cancer. Ann Surg. 1984;199(5):502-7.
  4. Serrablo A, Paliogiannis P, Pulighe F, Moro SS, Borrego-Estella V, Attene F, et al. Impact of novel histopathological factors on the outcomes of liver surgery for colorectal cancer metastases. Eur J Surg Oncol. 2016;42(9):1268-77.
  5. Abdalla EK, Vauthey J-N, 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(6):818-27.
  6. Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247(1):125-35.
  7. Phelip JM, Bouché O, Conroy T, Michel P, Penna C, Tournigand C, Louvet C, Bedenne L. «Cancer colorectal métastatique». Thésaurus National de Cancérologie Digestive, juin 2016, [http://www.snfge.org/tncd]
  8. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by Chemotherapy. Ann Surg. 2004;240:242-56.
  9. Zakaria S, Donohue JH, Que FG, Farnell MB, Schleck CD, Ilstrup DM, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246(2):183-91.
  10. de Haas RJ, Wicherts DA, Salloum C, Andreani P, Sotirov D, Adam R, et al. Long-term outcomes after hepatic resection for colorectal metastases in young patients. Cancer. 2010;116(3):647-58.
  11. House MG, Ito H, Gonen 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(5):744-55.
  12. Arru M, Aldrighetti L, Castoldi R, Di Palo S, Orsenigo E, Stella M, et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg. 2008;32(1):93-103.
  13. 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(6):860-70.
  14. Kanemitsu Y, Kato T. Prognostic models for predicting death after hepatectomy in individuals with hepatic metastases from colorectal cancer. World J Surg. 2008;32(6):1097-107. 15. 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(3):438-50.
  15. 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(3):438-50.
  16. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical Resection of Colorectal Carcinoma Metastases to the Liver : A Prognostic Scoring System to Improve Case Selection Based on 1568 Patients. Am Cancer Soc. 1996;77:1254-62.
  17. Wang Y, Liu YF, Cheng Y, Yi DH, Li P, Song WQ, et al. Prognosis of colorectal cancer with liver metastasis: value of a prognostic index. Braz J Med Biol Res. 2010;43(11):1116-22.
  18. 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(5):715-24.
  19. Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y, et al. Genetic and Histological Assessment of Surgical Margins in Resected Liver Metastases From Colorectal Carcinoma. Minimum Surgical Margins for Successful Resection. Arch Surg. 2002;137:833-40.
  20. Wei AC, Greig PD, Grant D, Taylor B, Langer B, Gallinger S. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol. 2006;13(5):668-76.
  21. Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M, et al. Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg. 2001;181:153-9.
  22. Matsumura M, Mise Y, Saiura A, Inoue Y, Ishizawa T, Ichida H, et al. Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases. Ann Surg Oncol. 2016;23(11):3718-26.
  23. Chirica M, Leconte M, Oberlin O, Dousset B. Surgical treatment of liver metastasis in patients with colorectal cancer. Presse Med. 2012;41(1):58-67.
  24. Blazer DG, Kishi Y, Maru DM, Kopetz S, Chun YS, Overman MJ, et al. Pathologic Response to Preoperative Chemotherapy: A New Outcome End Point After Resection of Hepatic Colorectal Metastases. J Clin Oncol. 2008;26(33):5344-51.
  25. Akyuz M, Aucejo F, Quintini C, Miller C, Fung J, Berber E. Factors affecting surgical margin recurrence after hepatectomy for colorectal liver metastases. Gland Surg. 2016;5(3):263-9.
  26. Sadot E, Groot Koerkamp B, Leal JN, Shia J, Gonen M, Allen PJ, et al. Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate? Ann Surg. 2015;262(3):476-85.