Hepatic resection for colorectal metastases - Analysis of prognostic factors

PURPOSE: Hepatic resection affords the best hope of survival for patients w ith colorectal carcinoma metastatic to the liver. However, recurrences are observed in about 60 percent of patients after curative hepatic resection. The purpose of this study was to examine the prognostic factors of patients undergoing curative hepatic resection for colorectal metastases. METHODS: Between April 1984 and September 1997, 168 patients underwent curative hepa tic resection for colorectal metastases. The clinicopathologic factors stud ied for prognostic value were gender, age, primary site, nodal status of pr imary tumor, time of metastases, preoperative serum level of carcinoembryon ic antigen, hepatic tumor size and distribution, number of metastases; type of hepatic resection, resection margin, presence of micrometastases in res ected specimen and microscopic fibrous pseudocapsule between the hepatic tu mor and surrounding hepatic parenchyma, nodal status of hepatoduodenal liga ment, adjuvant regional chemotherapy, and perioperative transfusion. RESULT S: The overall survival was 42 percent at three years and 26 percent at fiv e years, including a 3.5 percent 60-day surgical mortality rate. Thirty-one percent of patients had micrometastases located at a median distance of 3 mm from the metastatic tumor edge. Presence of microscopic fibrous pseudoca psule was observed in 28 percent of patients. Univariate and multivariate a nalyses showed that significant prognostic factors for survival were nodal status of primary tumor, number of metastases, resection margin, microscopi c fibrous pseudocapsule, and adjuvant regional chemotherapy. CONCLUSIONS: W e conclude that 1) hepatic resection is effective in select patients with c olorectal metastases; 2) adequate resection margin and adjuvant regional ch emotherapy can improve outcome; and 3) microscopic fibrous pseudocapsule ma y offer additional postoperative information as an independent prognostic f actor.