Abstract
Aim: Colorectal cancer is among the most common malignancies and liver metastasis is developed in 50% of the patients. Hepatic resection is the most effective treatment in liver metastasis of colorectal cancer. The present study aimed to determine the factors that affect survival in patients who underwent hepatic resection in liver metastasis of colorectal cancer.
Materials and Methods: The data on patients who underwent hepatic resection due to liver metastasis of colorectal cancer in Ege University, Faculty of Medicine, General Surgery Department were retrospectively analyzed. Survival data were collected with the review of patient follow-up files. The effects of the factors pertaining to the patients on survival were determined.
Results: The mean age of the 62 participating patients was 58.08 ± 10.92 years. Total survival rate was 50.4 months (CI: 41.2-59.7). The factors that statistically significantly reduced the survival rate were determined as follows: Patient age> 65 (<65 years: 56.4 ± 5.5 months / ≥65 years: 29.3 ± 4.8 months, p = 0.007), presence of more than four lymph node metastases in the primary tumor (N0: 56.1 ± 7.9 months / N1: 56.5 ± 6.5 months / N2: 18.0 ± 3.0, p = 0.001), presence of bilobular liver metastasis (Uni-lobular: 53.4 ± 5.0 months / bilobular: 24.0 ± 4.4 months, p = 0.026), and liver resection margin closer than 2 mm (<2 mm: 28.4 ± 7.7 months / 2-9 mm: 61.1 ± 7 , 6 months, ≥10mm: 46.3 ± 5.9 months, p = 0.003). No statistically significant differences were determined in survival based on gender, location of the primary tumor, the invasion depth of the primary tumor, the time between colorectal and liver surgery, the carcinoembryonic antigen level, the metastasis diameter, the number of metastases and the extent of surgical resection.
Conclusion: In patients who underwent surgical resection for liver metastasis of colorectal cancer, age older than sixty-five years, the presence of more than four lymph nodes in the colon resection material, bilobular liver metastasis, and a surgical margin closer than 2 mm were poor prognostic factors.
References
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov 1; 68 (6): 394–424.
- Kemeny N. The management of resectable and unresectable liver metastases from colorectal cancer. Vol. 22, Current Opinion in Oncology. Curr Opin Oncol; 2010. p. 364–73.
- Ünal NG, Coşgun G, Korkut M, Özütemiz AÖ, Doğanavşargil B, Çakar B, et al. Ege Üniversitesi Tıp Fakültesi veri tabanındaki kolorektal kanserli olguların epidemiyolojik ve genel sağ kalım özellikleri. Ege Tıp Derg. 2019 Dec 31; 58: 68–77.
- Rashidian N, Alseidi A, Kirks RC. Cancers Metastatic to the Liver. Vol. 100, Surgical Clinics of North America. W.B. Saunders; 2020. p. 551–63.
- Varol U, Karaca B, Cakar B, Sezgin C, Karabulut B, Uslu R. Comparing time to disease progression of irinotecan and oxaliplatin-based chemotherapies in colorectal cancer patients with liver only metastasis. Vol. 36, American Journal of Clinical Oncology: Cancer Clinical Trials. Am J Clin Oncol; 2013. p. 388–91.
- Cokmert S, Ellidokuz H, Demir L, Fuzun M, Astarcioglu I, Aslan D, et al. Survival outcomes of liver metastasectomy in colorectal cancer cases: A single-center analysis in Turkey. Asian Pacific J Cancer Prev. 2014; 15 (13): 5195–200.
- Adams RB, Aloia TA, Loyer E, Pawlik TM, Taouli B, Vauthey JN. Selection for hepatic resection of colorectal liver metastases: Expert consensus statement. HPB. 2013 Feb 1; 15 (2): 91–103.
- Cattell R. Successful removal of a liver metastasis from carcinoma of the rectum. Lahey Clin Bull. 1940; (2): 7–11.
- 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 (5): 502–8.
- Ekberg H, Tranberg K ‐G, Andersson R, Lundstedt C, Hägerstrand I, Ranstam J, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986; 73 (9):727–31.
- 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. Cancer. 1996 Apr 1; 77 (7): 1254–62.
- 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. In: Annals of Surgery. Ann Surg; 1999. p. 309–21.
- Di Giorgio A, Tocchi A, Puntillo G, Botti G, Derme G, Basso L, et al. Age as a prognostic factor following excisional surgery for colorectal cancer. Ann Ital Chir. 1990;61(6):647–50.
- Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67 (2): 93–9.
- Schindl M, Wigmore SJ, Currie EJ, Laengle F, Garden OJ. Prognostic scoring in colorectal cancer liver metastases: Development and validation. Arch Surg. 2005 Feb; 140 (2): 183–9.
- Rees M, Tekkis PP, Welsh FKS, 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 Jan; 247 (1): 125–35.
- Konopke R, Kersting S, Distler M, Dietrich J, Gastmeier J, Heller A, et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases. Liver Int. 2009; 29 (1): 89–102.
- Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer. 2018 Jan 15; 18 (1): 78.
- Iwatsuki S, Dvorchik I, Madariaga JR, Wallis Marsh J, Dodson F, Bonham AC, et al. Hepatic resection for metastatic colorectal adenocarcinoma: A proposal of a prognostic scoring system. J Am Coll Surg. 1999 Sep; 189 (3): 291–9.
- Zakaria S, Donohue JH, Que FG, Farnell MB, Schleck CD, Ilstrup DM, et al. Hepatic resection for colorectal metastases: Value for risk scoring systems? Vol. 246, Annals of Surgery. Ann Surg; 2007. p. 183–91.
- Silberhumer GR, Paty PB, Temple LK, Araujo RLC, Denton B, Gonen M, et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg. 2015 Jun 1; 209 (6): 935–42.
- Nikfarjam M, Shereef S, Kimchi ET, Gusani NJ, Jiang Y, Avella DM, et al. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol. 2009 Jul; 16 (7): 1860–7.
- Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: The impact of surgical margin status on outcome. HPB. 2010; 12 (1): 43–9.
- Cady B, Jenkins RL, Steele GD, Lewis WD, Stone MD, McDermott W V., et al. Surgical margin in hepatic resection for colorectal metastasis: A critical and improvable determinant of outcome. Ann Surg. 1998 Apr; 227 (4): 566–71.
- Wakai T, Shirai Y, Sakata J, Valera VA, Korita P V., Akazawa K, et al. Appraisal of 1 cm hepatectomy margins for intrahepatic micrometastases in patients with colorectal carcinoma liver metastasis. Ann Surg Oncol. 2008 Sep; 15 (9): 2472–81.
- Margonis GA, Sergentanis TN, Ntanasis-Stathopoulos I, Andreatos N, Tzanninis IG, Sasaki K, et al. Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis. Ann Surg. 2018 Jun 1; 267 (6): 1047–55.
- 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 (7): 833–40.
- Nuzzo G, Giuliante F, Ardito F, Vellone M, Giovannini I, Federico B, et al. Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery. 2008 Mar; 143 (3): 384–93.
- Hamady ZZR, Lodge JPA, Welsh FK, Toogood GJ, White A, John T, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: A propensity score case-match approach. Ann Surg. 2014 Mar; 259 (3): 543–8.
- Pawlik TM, Vauthey JN. Surgical margins during hepatic surgery for colorectal liver metastases: Complete resection not millimeters defines outcome. Vol. 15, Annals of Surgical Oncology. Ann Surg Oncol; 2008. p. 677–9.
Abstract
Amaç: Kolorektal kanser en sık görülen malignitelerden biridir ve hastaların %50’sinde karaciğer metastazı gelişir. Kolorektal kanserlerin karaciğer metastazlarında hepatik rezeksiyon en etkili tedavi yöntemidir. Bu çalışmanın amacı kolorektal kanserlerin karaciğer metastazında hepatik rezeksiyon uygulanan hastalarda sağ kalımı etkileyen faktörlerin ortaya konmasıdır.
Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı’nda kolorektal kanserin karaciğer metastazı nedeniyle hepatik rezeksiyon uygulanmış olan hastaların verileri retrospektif olarak incelendi. Hastaların takip dosyaları incelenerek sağ kalım verileri elde edildi. Hastalara ait faktörlerin sağ kalıma etkisi değerlendirildi.
Bulgular: Çalışmaya dâhil edilen 62 hastanın yaş ortalaması 58,08±10,92 idi. Genel sağ kalım ortalaması 50,4 ay (CI: 41,2-59,7) olarak saptandı. Hasta yaşının 65’ten büyük olması (<65 yıl:56,4±5,5 ay / ≥65 yıl:29,3±4,8 ay, p=0,007), primer tümörde dörtten fazla lenf nodu metastazı olması (N0:56,1±7,9 ay/ N1:56,5±6,5 ay/ N2:18,0±3,0, p=0,001), bilober karaciğer metastazı varlığı (Unilober: 53,4±5,0 ay/ bilober: 24,0±4,4 ay, p=0,026) ve karaciğer rezeksiyon sınırının 2 mm’den yakın olması (<2 mm: 28,4±7,7 ay/ 2-9 mm:61,1±7,6ay, ≥10mm: 46,3±5,9ay, p=0,003) istatistiksel olarak anlamlı şekilde sağ kalımı azaltan faktörler olarak saptandı. Cinsiyet, primer tümörün yerleşimi, primer tümörün invazyon derinliği, kolorektal ve karaciğer cerrahisi arasındaki süre, karsinoembriyonik antijen düzeyi, metastazın çapı, metastaz sayısı ve cerrahi rezeksiyonun genişliği ile sağ kalım süresi arasında istatiksel olarak anlamlı fark saptanmadı
Sonuç: Kolorektal kanserin karaciğer metastazına yönelik cerrahi rezeksiyon uygulanan hastalarda, 65 yaşından büyük olmak, kolon rezeksiyon materyalinde dörtten fazla lenf nodu olması, bilober karaciğer metastazı ve cerrahi sınırın 2 mm’den yakın olması kötü prognostik faktörlerdir.
References
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov 1; 68 (6): 394–424.
- Kemeny N. The management of resectable and unresectable liver metastases from colorectal cancer. Vol. 22, Current Opinion in Oncology. Curr Opin Oncol; 2010. p. 364–73.
- Ünal NG, Coşgun G, Korkut M, Özütemiz AÖ, Doğanavşargil B, Çakar B, et al. Ege Üniversitesi Tıp Fakültesi veri tabanındaki kolorektal kanserli olguların epidemiyolojik ve genel sağ kalım özellikleri. Ege Tıp Derg. 2019 Dec 31; 58: 68–77.
- Rashidian N, Alseidi A, Kirks RC. Cancers Metastatic to the Liver. Vol. 100, Surgical Clinics of North America. W.B. Saunders; 2020. p. 551–63.
- Varol U, Karaca B, Cakar B, Sezgin C, Karabulut B, Uslu R. Comparing time to disease progression of irinotecan and oxaliplatin-based chemotherapies in colorectal cancer patients with liver only metastasis. Vol. 36, American Journal of Clinical Oncology: Cancer Clinical Trials. Am J Clin Oncol; 2013. p. 388–91.
- Cokmert S, Ellidokuz H, Demir L, Fuzun M, Astarcioglu I, Aslan D, et al. Survival outcomes of liver metastasectomy in colorectal cancer cases: A single-center analysis in Turkey. Asian Pacific J Cancer Prev. 2014; 15 (13): 5195–200.
- Adams RB, Aloia TA, Loyer E, Pawlik TM, Taouli B, Vauthey JN. Selection for hepatic resection of colorectal liver metastases: Expert consensus statement. HPB. 2013 Feb 1; 15 (2): 91–103.
- Cattell R. Successful removal of a liver metastasis from carcinoma of the rectum. Lahey Clin Bull. 1940; (2): 7–11.
- 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 (5): 502–8.
- Ekberg H, Tranberg K ‐G, Andersson R, Lundstedt C, Hägerstrand I, Ranstam J, et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg. 1986; 73 (9):727–31.
- 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. Cancer. 1996 Apr 1; 77 (7): 1254–62.
- 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. In: Annals of Surgery. Ann Surg; 1999. p. 309–21.
- Di Giorgio A, Tocchi A, Puntillo G, Botti G, Derme G, Basso L, et al. Age as a prognostic factor following excisional surgery for colorectal cancer. Ann Ital Chir. 1990;61(6):647–50.
- Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67 (2): 93–9.
- Schindl M, Wigmore SJ, Currie EJ, Laengle F, Garden OJ. Prognostic scoring in colorectal cancer liver metastases: Development and validation. Arch Surg. 2005 Feb; 140 (2): 183–9.
- Rees M, Tekkis PP, Welsh FKS, 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 Jan; 247 (1): 125–35.
- Konopke R, Kersting S, Distler M, Dietrich J, Gastmeier J, Heller A, et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases. Liver Int. 2009; 29 (1): 89–102.
- Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J. Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer. 2018 Jan 15; 18 (1): 78.
- Iwatsuki S, Dvorchik I, Madariaga JR, Wallis Marsh J, Dodson F, Bonham AC, et al. Hepatic resection for metastatic colorectal adenocarcinoma: A proposal of a prognostic scoring system. J Am Coll Surg. 1999 Sep; 189 (3): 291–9.
- Zakaria S, Donohue JH, Que FG, Farnell MB, Schleck CD, Ilstrup DM, et al. Hepatic resection for colorectal metastases: Value for risk scoring systems? Vol. 246, Annals of Surgery. Ann Surg; 2007. p. 183–91.
- Silberhumer GR, Paty PB, Temple LK, Araujo RLC, Denton B, Gonen M, et al. Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg. 2015 Jun 1; 209 (6): 935–42.
- Nikfarjam M, Shereef S, Kimchi ET, Gusani NJ, Jiang Y, Avella DM, et al. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol. 2009 Jul; 16 (7): 1860–7.
- Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: The impact of surgical margin status on outcome. HPB. 2010; 12 (1): 43–9.
- Cady B, Jenkins RL, Steele GD, Lewis WD, Stone MD, McDermott W V., et al. Surgical margin in hepatic resection for colorectal metastasis: A critical and improvable determinant of outcome. Ann Surg. 1998 Apr; 227 (4): 566–71.
- Wakai T, Shirai Y, Sakata J, Valera VA, Korita P V., Akazawa K, et al. Appraisal of 1 cm hepatectomy margins for intrahepatic micrometastases in patients with colorectal carcinoma liver metastasis. Ann Surg Oncol. 2008 Sep; 15 (9): 2472–81.
- Margonis GA, Sergentanis TN, Ntanasis-Stathopoulos I, Andreatos N, Tzanninis IG, Sasaki K, et al. Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis. Ann Surg. 2018 Jun 1; 267 (6): 1047–55.
- 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 (7): 833–40.
- Nuzzo G, Giuliante F, Ardito F, Vellone M, Giovannini I, Federico B, et al. Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery. 2008 Mar; 143 (3): 384–93.
- Hamady ZZR, Lodge JPA, Welsh FK, Toogood GJ, White A, John T, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: A propensity score case-match approach. Ann Surg. 2014 Mar; 259 (3): 543–8.
- Pawlik TM, Vauthey JN. Surgical margins during hepatic surgery for colorectal liver metastases: Complete resection not millimeters defines outcome. Vol. 15, Annals of Surgical Oncology. Ann Surg Oncol; 2008. p. 677–9.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 22, 2021 |
| Submission Date | January 14, 2021 |
| Published in Issue | Year 2021Volume: 60 Issue: 4 |
