Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease

Results in 127 patients treated at a single center

Darren R. Carpizo, Chandrakanth Are, William Jarnagin, Ronald Dematteo, Yuman Fong, Mithat Gönen, Leslie Blumgart, Michael D'Angelica

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background: Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome. Methods: From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses. Results: Median follow-up was 24 months (range 3-152 months). The 3- and 5-year survival for patients with concomitant EHD were 47% and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95% recurred. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.

Original languageEnglish (US)
Pages (from-to)2138-2146
Number of pages9
JournalAnnals of Surgical Oncology
Volume16
Issue number8
DOIs
StatePublished - Aug 1 2009

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Colorectal Neoplasms
Liver
Survival
Neoplasm Metastasis
Recurrence
Multivariate Analysis
Survival Rate
Lymph Nodes
Drug Therapy
Lung

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease : Results in 127 patients treated at a single center. / Carpizo, Darren R.; Are, Chandrakanth; Jarnagin, William; Dematteo, Ronald; Fong, Yuman; Gönen, Mithat; Blumgart, Leslie; D'Angelica, Michael.

In: Annals of Surgical Oncology, Vol. 16, No. 8, 01.08.2009, p. 2138-2146.

Research output: Contribution to journalArticle

Carpizo, Darren R. ; Are, Chandrakanth ; Jarnagin, William ; Dematteo, Ronald ; Fong, Yuman ; Gönen, Mithat ; Blumgart, Leslie ; D'Angelica, Michael. / Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease : Results in 127 patients treated at a single center. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 8. pp. 2138-2146.
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abstract = "Background: Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome. Methods: From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9{\%}) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses. Results: Median follow-up was 24 months (range 3-152 months). The 3- and 5-year survival for patients with concomitant EHD were 47{\%} and 26{\%}, respectively, compared with 67{\%} and 49{\%}, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95{\%} recurred. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.",
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N2 - Background: Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome. Methods: From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses. Results: Median follow-up was 24 months (range 3-152 months). The 3- and 5-year survival for patients with concomitant EHD were 47% and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95% recurred. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.

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