Surgical outcomes in patients with hepatic synchronous and metachronous colorectal metastases


COD: 06_2017_05-2748 Categorie: ,

Maria Laura Cossu, Giorgio Carlo Ginesu, Claudio Francesco Feo, Alessandro Fancellu, Antonio Pinna, Isabel Vargiu, Francesca Addis, Michele Barmina, Giovanni Sotgiu, Alberto Porcu

Ann Ital Chir, 2017 88, 6: 497-504
Epub Ahead of Print November 6 2017

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METHODS: Eighty-four liver metastasectomies in 77 consecutive patients with 90 colorectal cancer hepatic metastases were
performed in our institution from 2009 to 2014. Surgery was carried out in 75 cases, as two patients were not eligible
for surgery. Among them 43 (Group A) were affected by synchronous, and 32 (Group B) by metachronous lesions.
Furthermore, 9 reoperations were performed in patients with initially synchronous lesions. The follow-up after surgery
included total body CT scan every 3 months for the first year, and every 6 months for 4 years thereafter. Blood level
of CEA was determined every 3 months.
RESULTS: The univariate analysis evidenced significantly more recurrences in patients with synchronous lesions (p=0.011),
and higher grade, pN stage and CEA blood levels. In multivariate logistic regression analysis the statistically significant
parameters found were: the pT stage (OR: 3.92, p = 0.039), the use of adjuvant chemotherapy for the colonic tumor
(OR: 0.19, p = 0.025), and the adjuvant chemotherapy (OR: 4.11, p = 0.048). The global survival was 32 patients
(41.5%), 17 with synchronous and 15 with metachronous lesions, and a significant difference in long-term survival
between these two groups was found (p = 0.008).
CONCLUSIONS: The most relevant prognostic factor in patients with hepatic colorectal cancer dissemination is the timing
of metastasis; the metachronous lesions present better survival when surgically treated.