Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

Abstract

Background: Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy. Methods: Patients who had radical resection of primary colorectal cancer in 2009-2013 were identified in a population-based Swedish colorectal registry and cross-checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed.Results: Radical resection was registered in 20 853 patients; in 38⋅7 per cent of those registered with liver metastases, surgery or ablation was performed. The age-standardized relative 5-year survival rate after radical resection of colorectal cancer was 80⋅9 (95 per cent c.i. 80⋅2 to 81⋅6) per cent, and the rate after surgery for colorectal liver metastases was 49⋅6 (46⋅0 to 53⋅2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection.Conclusion: Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.

Exploring the effect of microecological agents on postoperative immune function in patients undergoing liver cancer surgery: a systematic review and meta-analysis

“…In patients with primary liver cancer with enema, routine enema before surgery and decreased bile secretion after surgery can cause changes in intestinal acidity and alkalinity, which can lead to imbalance of the flora in the patient's body (5). At the same time, the antibiotics used to prevent infection after the operation will kill the sensitive bacteria in the intestinal tract, making the resistant bacteria colonize in large numbers, destroying the normal distribution of the intestinal flora in the patient's body (6). Fasting after liver resection in patients will lead to a reduction in related amino acids and energy intake, which in turn induces a decrease in the permeability of the intestinal mucosa and a weakened barrier function (7).…”

Pros and Cons of Portal Vein Embolization With Hematopoietic Stem Cells Application in Colorectal Liver Metastases Surgery

“…Our current results show a trend towards more rapid CLMs progression and subsequent worse RFS and OS in patients with an overall greater number and larger volume of CLMs, although we were unable to demonstrate an unequivocal statistical significance of either of these factors given the size of our sample. The biological activity and location of the primary tumour also undoubtedly plays a role (21)(22)(23). Further clinical and experimental research is needed to address these issues.…”

Is Laterality Prognostic in Resected KRAS-Mutated Colorectal Liver Metastases? A Systematic Review and Meta-Analysis

“…In 2016, Sasaki et al suggested that PTL may be associated with worse overall survival (OS) in patients with resected colorectal cancer liver metastases (CRLM) [4]. Since then, most studies in patients with CRLM confirmed that RS primary tumors may show worse OS [5], although others did not show a relationship between PTL and long-term mortality [6,7]. Wang et al performed the first meta-analysis which showed that RS tumors have worse OS than LS tumors [8].…”