EXPERIENCE IN HEPATIC RESECTION FOR METASTATIC COLORECTAL-CANCER - ANALYSIS OF CLINICAL AND PATHOLOGICAL RISK-FACTORS

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 inf luence survival. Methods. Between January 1981 and December 1991, 204 patients underwent curative hepatic resection for metastatic colorecta l cancer. Fourteen clinical and pathologic determinants previously rep orted 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 97%, 43%, and 32%, respectively. Ge nder, Dukes' classification, site of primary colorectal cancer, histol ogic differentiation, size of metastatic tumor, and intraoperative blo od transfusion requirement were not statistically significant prognost ic factors (p > 0.05). Age of 60 years or more, interval of 24 months or less between colorectal and hepatic resection, Sour or more gross t umors, bilobar involvement, positive resection margin, lymph node invo lvement, and direct invasion to adjacent organs were significant poor prognostic factors (p < 0.05) In the absence of nodal disease or direc t invasion, patients with unilobar solitary tumor of any size, or unil obar multiple tumors of 2 cm or smaller (stages I and III had the high est survival rates of 93% at 1 year, 68% at 3 years, and 61% at 5 year s. Unilobar disease with multiple lesions greater than 2 cm (stage III ) resulted in 1-, 3-, and 5-year survivals of 98%, 45%;, and 28%, resp ectively. Patients with bilobar involvement (multiple tumors, any size , or a single large metastasis) (stage IV A) 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) experience d the poorest outcome with 1-, 3-, and 5-year survivals of 80%, 12%, a nd 0%, respectively (p < 0.00001). Conclusions. The proposed nTNM stag ing system appears to be useful in predicting the outcomes after hepat ic resection of metastatic colorectal tumors.