Prognostic Factors Affecting Survival Rate Following Hepatic Resection for Metastatic Colorectal Cancer

ABSTRACT

PURPOSE: Hepatic resection for metastatic colorectal cancer has recently become a widely acceptable treatment modality due to its low surgical mortality and the significant improvement of 5 year survival rates seen after resection. However the use of this treatment modality remains controversial. The aim of study was to assess the survival benefits in patients who had undergone a hepatic resection for metastatic colorectal cancer as well as to determine the prognostic factors. METHODS: A retrospective study was conducted of 94 patients who had undergone curative hepatic resection for synchronous or metachronous metastatic colorectal cancer at Department of Surgery, Yonsei University College of Medicine, between June 1989 and June 2000. Cases demonstrating extrahepatic metastasis at the time of initial surgery were excluded. The survival rate was calculated using the Kaplan-Meier and Cox regression hazard model. The mean follow up period was 35 months. RESULTS: There were 58 (61.7%) and 36 (38.3%) cases of synchronous and metachronous metastasis, respectively. The 5 year survival rate was shown to be significantly lower in patients with more than 3 metastases (P=0.05), 4 or more regional lymph node metastases in primary colorectal cancer (P=0.02), bilobar metastasis (P=0.002), extra hepatic recurrence (P=0.03) and recurrence within 1 year after hepatic resection (P=0.001). Bilobar metastasis (P=0.004) and recurrence within I year (P=0.001) has been demonstrated independent factor for 5 year survival. The overall 5 year survival rate was 30.4%. CONCLUSION: Patients with multiple, bilobar hepatic metastasis demonstrated a poor survival rate. Extrahepatic recurrence within 1 year following hepatic resection was also related with a poor outcome. Therefore, in patients with poor prognostic factors, curative surgical resection accompanied by a multimodality treatment is necessary for the improvement of survival.