Predictors of long‐term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort

Abstract

Background Hepatic metastases are a major cause of death in patients with colorectal cancer. A comprehensive assessment of the prognostic factors associated with long‐term survival could improve patient selection for surgical approaches and decrease morbidity and futile locoregional treatments. Methods We performed a retrospective analysis of patients who underwent hepatectomy for colorectal liver metastases at a single center from 2000 to 2012. Results To identify factors associated with 5‐ and 10‐year overall (OS) and disease‐free survival (DFS), we analyzed 280 patients and 150 patients in the 5‐ and 10‐year cohorts, respectively. Only seven relapses occurred after 5 years of follow‐up, and no relapses occurred after 10 years. Multivariable analysis indicated that bilobar disease and extra‐hepatic disease before hepatectomy were independent 5‐ and 10‐year predictors of OS, and major postoperative complications predicted OS in the 5‐year survival cohort only. Our analysis indicated that prognostic factors associated with DFS included some confounders and was therefore inconclusive. Conclusions Taken together, our results suggest that the predictors of 5‐ and 10‐year OS rates of colorectal cancer patients with hepatic metastases are similar, differing only by postoperative complications that influenced exclusively 5‐year survival. Since no relapse occurred 10 years after hepatic resection, oncological remission is likely.

Postoperative complications predict poor outcomes only in patients with a low modified clinical score after resection of colorectal liver metastases: a retrospective cohort study

“…Therefore, our study evaluated the prognostic impact of several popular definitions. Some differences between our study and other reports were noted [ 6 , 8 , 9 ]. We found that infective complications and major complications did not affect the short-term or long-term survival of the patients.…”

“…A number of previous studies have shown that postoperative complications can reduce patients' long-term survival and increase the risk of disease recurrence in patients with CRLM [7][8][9][10][11]. However, the postoperative complication criteria to determine survival differ among studies.…”

“…However, the postoperative complication criteria to determine survival differ among studies. Mavros et al [ 7 ] stated that all postoperative complications were associated with shorter recurrence‐free survival (RFS) and overall survival (OS), whereas Vaz da Silva et al [ 8 ] and Fukami et al [ 9 ] proposed that Clavien–Dindo grade ≥ III complications predicted shorter OS. In addition, Moreno et al [ 10 ] suggested that only infective complications affect the long-term survival of patients with CRLM.…”

Analysis of survival factors after hepatic resection for colorectal cancer liver metastases: Does the R1 margin matter?

“…In recent years, the survival rate of colorectal cancer liver metastasis (CRLM) has increased significantly due to the development of chemotherapeutic agents, targeted drugs and combination therapy (6). However, radical surgery remains the most critical method to achieve long-term survival in CRLM, with 5-year survival rates ranging from 40%-60% (2,4,7,8). The liver margin is an important factor in determining whether radical treatment can be achieved.…”

Brazilian Society of Surgical Oncology surgical standards for resectable colorectal cancer liver metastases

“…72 Despite attempts to predict recurrence after resection with the proposed scores and prognostic factors, results are heterogeneous, and foreseeing relapse remains a challenge on an individual case basis. 40,45,73,74 Rehepatectomy (RH) or repeated hepatectomy (third and fourth liver resections) can be performed for resectable hepatic recurrence under circumstances where the remnant liver volume is sufficient and patients remain tolerant to surgery. [75][76][77] In these conditions, the procedure has shown adequate safety, with postoperative complications, mortality, and survival rates similar to those for the primary hepatectomy.…”