Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Comparative Outcome after Treatment for Synchronous vs. Metachronous Colorectal Cancer Liver Metastasis

  • Youn, Sang-Min (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Heo, Jin-Seok (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Dong-Wook (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yun, Seong-Hyeon (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chun, Ho-Kyung (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Woo-Yong (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Seong-Ho (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hee-Cheol (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Yong-Bum (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2010.09.30
⟨ Previous Next ⟩

Abstract

Purpose: This study was designed to compare outcomes in patients who underwent hepatectomy or radiofrequency thermal ablation (RFA) for synchronous or metachronous colorectal liver metastases (CLM). Methods: One hundred twenty-two patients who underwent hepatectomy or RFA for their first CLM between 2001 and 2004 were enrolled in this study. The patients were divided into two groups (synchronous [N=77] and metachronous [N=45] CLM). Patient characteristics, clinicopathologic features, long-term outcomes, and prognostic factors were analyzed retrospectively. Results: There were no significant differences in the 5-year disease-free and overall survival rates between the synchronous and metachronous CLM groups (36.2% vs. 37.2%, p=0.78; and 53.0% vs. 54.4%, p=0.82, respectively). Patients in the synchronous CLM group underwent more bilobar hepatic resections, intra-operative RFA, or co-modality treatments than the metachronous CLM group (p=0.035). The surgical resection group had a longer disease-free survival, but not overall survival than the RFA group. Greater N stage and female gender were associated with a worse prognosis in overall survival; N0 stage and surgical resection were good prognostic factors for disease-free survival. N stage and surgical resection were also statistically significant prognostic factors based on multivariate analysis. Conclusion: The synchronicity of CLM is not a significant prognostic factor, but the clinicopathologic characteristics that reflect more disseminated disease than metachronous metastasis are significant prognostic factors. Tumor characteristics and aggressiveness may be more important for prognosis than chronology.

Keywords

References

  1. Boring CC, Squires TS, Tong T. Cancer statistics, 1992. CA Cancer J Clin 1992;42:19-38. https://doi.org/10.3322/canjclin.42.1.19
  2. Jung SH, Kim HC, Kim AY, et al. Colorectal cancer presenting as an early recurrence within 1 year after a curative resection. J Korean Soc Coloproctol 2008;24:265-272. https://doi.org/10.3393/jksc.2008.24.4.265
  3. Kobayashi H, Mochizuki H, Sugihara K, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 2007;141: 67-75. https://doi.org/10.1016/j.surg.2006.07.020
  4. South and West Cancer Intelligence Unit. Wessex Colorectal Audit: Final Report, 5-Year Outcomes. Winchester: South and West Cancer Intelligence Unit; 2000.
  5. Jaffe BM, Donegan WL, Watson F, Spratt JS Jr. Factors influencing survival in patients with untreated hepatic metastases. Surg Gynecol Obstet 1968;127:1-11.
  6. Bengmark S, Hafström L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer 1969;23:198-202. https://doi.org/10.1002/1097-0142(196901)23:1<198::AID-CNCR2820230126>3.0.CO;2-J
  7. Chang AE, Schneider PD, Sugarbaker PH, Simpson C, Culnane M, Steinberg SM. A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Ann Surg 1987;206:685-693. https://doi.org/10.1097/00000658-198712000-00001
  8. Cunningham D, Pyrhonen S, James RD, et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998;352:1413-1418. https://doi.org/10.1016/S0140-6736(98)02309-5
  9. August DA, Ottow RT, Sugarbaker PH. Clinical perspective of human colorectal cancer metastasis. Cancer Metastasis Rev 1984;3:303-324. https://doi.org/10.1007/BF00051457
  10. Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991;110:13-29.
  11. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1,001 consecutive cases. Ann Surg 1999;230:309-318 https://doi.org/10.1097/00000658-199909000-00004
  12. Tsai MS, Su YH, Ho MC, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol 2007;14:786-794. https://doi.org/10.1245/s10434-006-9215-5
  13. Holm A, Bradley E, Aldrete JS. Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrence. Ann Surg 1989;209:428-434. https://doi.org/10.1097/00000658-198904000-00007
  14. Bockhorn M, Frilling A, Frühauf NR, et al. Survival of patients with synchronous and metachronous colorectal liver metastases-- is there a difference? J Gastrointest Surg 2008;12:1399-1405. https://doi.org/10.1007/s11605-008-0508-9
  15. Lee WS, Yun SH, Chun HK, et al. Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis. J Clin Gastroenterol 2008;42:945-949. https://doi.org/10.1097/MCG.0b013e318064e752
  16. Rosen M, Chan L, Beart RW Jr, Vukasin P, Anthone G. Follow-up of colorectal cancer: a meta-analysis. Dis Colon Rectum 1998;41:1116-1126. https://doi.org/10.1007/BF02239433
  17. Sadahiro S, Suzuki T, Ishikawa K, et al. Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years. Hepatogastroenterology 2003;50:1362-1366.
  18. Ballantyne GH, Quin J. Surgical treatment of liver metastases in patients with colorectal cancer. Cancer 1993;71(12 Suppl): 4252-4266. https://doi.org/10.1002/1097-0142(19930615)71:12+<4252::AID-CNCR2820711815>3.0.CO;2-6
  19. Harmon KE, Ryan JA Jr, Biehl TR, Lee FT. Benefits and safety of hepatic resection for colorectal metastases. Am J Surg 1999;177:402-404. https://doi.org/10.1016/S0002-9610(99)00070-7
  20. Sugihara K, Hojo K, Moriya Y, Yamasaki S, Kosuge T, Takayama T. Ern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993;80:1032-1035. https://doi.org/10.1002/bjs.1800800837
  21. Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases. A multiinstitutional study of long-term survivors. Dis Colon Rectum 1988;31:1-4. https://doi.org/10.1007/BF02552560
  22. Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg 1984;119:647-651. https://doi.org/10.1001/archsurg.1984.01390180015003
  23. Stone MD, Cady B, Jenkins RL, McDermott WV, Steele GD Jr. Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg 1990;125:718-721. https://doi.org/10.1001/archsurg.1990.01410180036007
  24. Huguet C, Bona S, Nordlinger B, et al. Repeat hepatic resection for primary and metastatic carcinoma of the liver. Surg Gynecol Obstet 1990;171:398-402.
  25. Bozzetti F, Doci R, Bignami P, Morabito A, Gennari L. Patterns of failure following surgical resection of colorectal cancer liver metastases. Rationale for a multimodal approach. Ann Surg 1987;205:264-270. https://doi.org/10.1097/00000658-198703000-00008
  26. Silen W. Hepatic resection for metastases from colorectal carcinoma is of dubious value. Arch Surg 1989;124:1021- 1022. https://doi.org/10.1001/archsurg.1989.01410090027004
  27. Tandan VR, Harmantas A, Gallinger S. Long-term survival after hepatic cryosurgery versus surgical resection for metastatic colorectal carcinoma: a critical review of the literature. Can J Surg 1997;40:175-181.
  28. Park IJ, Kim HC, Yu CS, Kim JC. Pattern of recurrences and metastases after a curative resection for primary colorectal cancer. J Korean Soc Coloproctol 2008;24:207-213. https://doi.org/10.3393/jksc.2008.24.3.207
  29. Park IJ, Kim HC, Yu CS, Kim PN, Won HJ, Kim JC. Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol 2008;15:227-232. https://doi.org/10.1245/s10434-007-9625-z
  30. Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg 1998;22: 268-276. https://doi.org/10.1007/s002689900381