Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis Kun-Ming Chan1*, Tsung-Han Wu1, Chih-Hsien Cheng1, Wei-Chen Lee1, Jy-Ming Chiang2, Jinn-Shiun Chen2 and Jeng-Yi Wang2
Abstract Background: Although liver resection (LR) for colorectal cancer (CRC) hepatic metastasis is the best strategy to improve patient outcomes, there are considerable concerns regarding the recurrence of CRC after LR. In this study, we investigated the prognostic indicators associated with CRC recurrence after LR for hepatic metastasis. Methods: This is a retrospective review of patients who underwent curative LR for CRC hepatic metastasis between January 2008 and December 2012. The clinicopathological features and outcome parameters affecting prognosis were analyzed. Results: A total of 332 LRs with curative intent were performed in 278 patients, of whom 168 (60.4%) experienced CRC recurrence after the first LR, and 206 of the 332 LRs (62.0%) developed CRC recurrence. A preoperative serum carcinoembryonic antigen level greater than 100 ng/mL and four or more metastatic tumor nodules were independent prognostic factors for CRC recurrence after LR. The disease-free survival rate after LR was significantly associated with the number of metastatic nodules. The patients who underwent surgical resection for recurrent CRC had favorable outcomes, with a five-year overall survival rate of 65.2%. Conclusion: The number of metastatic tumors significantly affects the outcomes of patients who undergo LR for CRC hepatic metastasis, indicating that a novel therapeutic strategy for patients at high risk may be required. However, favorable long-term outcomes are achievable through aggressive treatment with surgical resection of the recurrent CRC. Keywords: Colorectal cancer, Hepatic metastasis, Liver resection, Outcome
Background The liver is the most common site of distant spread of primary colorectal cancer (CRC), and over 50% of patients will develop hepatic metastasis during the course of their disease [1,2]. Liver resection (LR) is believed to provide the only chance of curative treatment, and has largely improved the long-term outcomes of these patients if the metastatic CRC is confined to the liver [2-4]. With the introduction of multidisciplinary treatment and the advancement of surgical management and chemotherapeutic * Correspondence: [email protected] 1 Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan Township, Taoyuan 33305, Taiwan Full list of author information is available at the end of the article
agents, the five-year survival rate following LR with curative intent for CRC hepatic metastasis has been reported to be up to 60% in recently published studies [5-7]. Nevertheless, despite the excellent results of surgical resection for metastatic CRC, it is estimated that more than half of the patients will still devel
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