Surgical Outcomes and Prognostic Factors in Patients With Synchronous Colorectal Liver Metastases

Abstract

-Context -Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objective -To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods -Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results -Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusion -Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%. HEADINGS -Liver neoplasms, surgery. Colorectal neoplasms, surgery. Neoplasm metastasis.

I Brazilian Consensus on Multimodal Treatment of Colorectal Liver Metastases. Module 2: Approach to Resectable Metastases

“…Synchronous colorectal liver metastases (CLM) are those diagnosed before, at the same time 1 or up to six months after the detection of the primary tumor. This definition is heterogeneous in the literature since different publications adopt different times of disease progression of the colorectal tumor to characterize the synchronicity of hepatic lesions, which include intervals of four months 2 , six months 3 , 4 and up to 12 months 5 , 6 . In this consensus, it was decided to adopt the interval of six months because this was the only that demonstrated impact on survival in prospective analysis 7 .…”

Metástasis hepáticas en el cáncer colorrectal: estrategias terapéuticas y recomendaciones actuales

“…Por esta razón, se afirma que la cirugía es el único tratamiento que impacta en la supervivencia a largo plazo y, en la actualidad, el esfuerzo terapéutico está dirigido a aumentar el número de candidatos a la resección quirúrgica, ya que solo 15 a 20 % de estos tumores puede resecarse cuando se hace el diagnóstico [10][11][12][13] . Actualmente, existen múltiples estrategias que permiten convertir los casos no aptos para resección en candidatos al manejo quirúrgico, con un impacto positivo en el pronóstico oncológico.…”

Rehepatectomia para tratamento da recorrência de metástases hepáticas de câncer colorretal: análise comparativa dos resultados precoces e tardios

“…[24][25][26] Observamos ainda mudança nos conceitos cirúrgicos, com o entendimento de que margens subcentimétricas podem garantir sobrevida tardia e a utilização crescente de técnicas poupadoras de parênquima. [27][28][29] Diversos estudos comparativos demonstraram que a realização de ressecções não-regradas mas com margens microscopicamente livres, visando a conservação de parênquima, não tem impacto negativo no prognóstico destes pacientes, cursando, ao contrário, com maior sobrevida após a recidiva hepática, por aumentar a chance de retratamento locorregional. 20,28 Concomitante a isso, houve uma mudança nos paradigmas do tratamento cirúrgico das MHCCR, desta forma, atualmente, a ressecção das lesões hepáticas não tem mais como limitantes o número, o tamanho ou o acometimento bilateral, e mesmo a presença de doença extra-hepática, desde que ressecável, não é uma contraindicação absoluta à ressecção em casos selecionados.…”