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Experience in hepatic resection for metastatic colorectal cancer: Analysis of clinical and pathologic risk factors

Gayowski, TJ and Iwatsuki, S and Madariaga, JR and Selby, R and Todo, S and Irish, W and Starzl, TE and Williams, JW and Doerr, RJ and Otta, D (1994) Experience in hepatic resection for metastatic colorectal cancer: Analysis of clinical and pathologic risk factors. Surgery, 116 (4). 703 - 711. ISSN 0039-6060

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Abstract

Background. The selection of patients for resective therapy of hepatic colorectal metastases remains controversial. A number of clinical and pathologic prognostic risk factors have been variably reported to influence survival. Methods. Between January 1981 and December 1991, 204 patients underwent curative hepatic resection for metastatic colorectal cancer. Fourteen clinical and pathologic determinants previously reported to influence outcome were examined retrospectively. This led to a proposed TNM staging system for metastatic colorectal cancer (mTNM). Results. No operative deaths occurred (death within 1 month). Overall 1-, 3-, and 5-year survivals were 91%, 43%, and 32%, respectively. Gender, Dukes' classification, site of primary colorectal cancer, histologic differentiation, size of metastatic tumor, and intraoperative blood transfusion requirement were not statistically significant prognostic factors (p > 0.05). Age of 60 years or more, interval of 24 months or less between colorectal and hepatic resection, four or more gross tumors, bilobar involvement, positive resection margin, lymph node involvement, and direct invasion to adjacent organs were significant poor prognostic factors (p < 0.05). In the absence of nodal disease or direct invasion, patients with unilobar solitary tumor of any size, or unilobar multiple tumors of 2 cm or smaller (stages I and II) had the highest survival rates of 93% at 1 year, 68% at 3 years, and 61% at 5 years. Unilobar disease with multiple lesions greater than 2 cm (stage III) resulted in 1-, 3-, and 5-year survivals of 98%, 45%, and 28%, respectively. Patients with bilobar involvement (multiple tumors, any size, or a single large metastasis) (stage IVA) had survival rates of 88% at 1 year, 28% at 3 years, and 20% at 5 years (p < 0.00001). Patients with nodal involvement or extrahepatic disease (stage IVB) experienced the poorest outcome with 1-, 3- , and 5-year survivals of 80%, 12%, and 0%, respectively (p < 0.00001). Conclusions. The proposed mTNM staging system appears to be useful in predicting the outcomes after hepatic resection of metastatic colorectal tumors.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Gayowski, TJ
Iwatsuki, S
Madariaga, JR
Selby, R
Todo, S
Irish, W
Starzl, TEtes11@pitt.eduTES11
Williams, JW
Doerr, RJ
Otta, D
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1994
Date Type: Publication
Journal or Publication Title: Surgery
Volume: 116
Number: 4
Page Range: 703 - 711
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0039-6060
Other ID: uls-drl:31735062125079, Starzl CV No. 1656
Date Deposited: 08 Apr 2010 17:28
Last Modified: 13 Oct 2017 20:57
URI: http://d-scholarship.pitt.edu/id/eprint/5042

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