Prognostic indicators lose their value with repeated resection of colorectal liver metastases
The liver is the most common site of colorectal liver metastases (CRLM) and surgical resection improves overall survival in selected patients. Here, we investigate outcomes and relevant prognostic factors after repeated hepatic resections for CRLM. From a prospective database, 578 patients who under...
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| Veröffentlicht in: | European journal of surgical oncology 2018-10, Vol.44 (10), p.1610-1618 |
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| creator | Schmidt, Thomas Nienhüser, Henrik Kuna, Constantin Klose, Johannes Strowitzki, Moritz J. Büchler, Markus W. Ulrich, Alexis Schneider, Martin |
| description | The liver is the most common site of colorectal liver metastases (CRLM) and surgical resection improves overall survival in selected patients. Here, we investigate outcomes and relevant prognostic factors after repeated hepatic resections for CRLM.
From a prospective database, 578 patients who underwent 788 resections of colorectal liver metastases were included into this study. In total, 169 patients underwent a second and 41 patients had a third operation due to intrahepatic metastatic recurrence. Univariate and multivariate analyses were performed to determine prognostic risk factors.
5-year overall survival was 36.7% (95% CI: 30.2%; 43.2%) and 10-year survival was 20.3% (95% CI: 7.6%; 33.0%) in patients undergoing single resection. In patients undergoing a second or third resection, 5- and 10-year survival rates were 56.6% (95% CI: 45.0%; 68.2%) and 21.9% (95% CI: 6.8%; 37.0%) or 53.2% (95% CI: 32.4%; 74.0%) and 25.4%, respectively. In patients undergoing single resection, established markers (number, size and pattern of CRLM [p = 0.030/0.015/ |
| doi_str_mv | 10.1016/j.ejso.2018.07.051 |
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From a prospective database, 578 patients who underwent 788 resections of colorectal liver metastases were included into this study. In total, 169 patients underwent a second and 41 patients had a third operation due to intrahepatic metastatic recurrence. Univariate and multivariate analyses were performed to determine prognostic risk factors.
5-year overall survival was 36.7% (95% CI: 30.2%; 43.2%) and 10-year survival was 20.3% (95% CI: 7.6%; 33.0%) in patients undergoing single resection. In patients undergoing a second or third resection, 5- and 10-year survival rates were 56.6% (95% CI: 45.0%; 68.2%) and 21.9% (95% CI: 6.8%; 37.0%) or 53.2% (95% CI: 32.4%; 74.0%) and 25.4%, respectively. In patients undergoing single resection, established markers (number, size and pattern of CRLM [p = 0.030/0.015/<0.001], R-status [p = 0.001], surgical/medical complications [p = 0.001/0.008], CEA-level [p = 0.001] and Fong-Score [p = 0.02]) were significantly associated with survival. In patients undergoing three resections, the only predictive markers were pT-stage of the primary tumor in univariate analysis (p = 0.013) and metachronous metastasis and medical complications in multivariate analysis (p = 0.001/0.025). The Fong-Score had no predictive value in patients undergoing two (p = 0.08) or three (p = 0.7) resections.
Established prognostic indicators are not applicable in patients undergoing repeated CRLM resection. In a highly-selected group of patients, repeated hepatic resections can be performed safely with favorable long-term outcomes.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2018.07.051</identifier><identifier>PMID: 30115500</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Carcinoembryonic Antigen - blood ; Colorectal cancer ; Colorectal metastases ; Colorectal Neoplasms - pathology ; Female ; Follow-Up Studies ; Fong-Score ; Hepatectomy - adverse effects ; Humans ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Liver surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local - secondary ; Neoplasm Recurrence, Local - surgery ; Neoplasm Staging ; Recurrence ; Reoperation ; Retrospective Studies ; Surgical oncology ; Survival Rate ; Tumor Burden</subject><ispartof>European journal of surgical oncology, 2018-10, Vol.44 (10), p.1610-1618</ispartof><rights>2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology</rights><rights>Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-5a08d57ec0e0229e04fdb0a4de1f6291129624c6648a2a042f9f5107639d46a63</citedby><cites>FETCH-LOGICAL-c356t-5a08d57ec0e0229e04fdb0a4de1f6291129624c6648a2a042f9f5107639d46a63</cites><orcidid>0000-0002-7166-3675</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S074879831831254X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30115500$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schmidt, Thomas</creatorcontrib><creatorcontrib>Nienhüser, Henrik</creatorcontrib><creatorcontrib>Kuna, Constantin</creatorcontrib><creatorcontrib>Klose, Johannes</creatorcontrib><creatorcontrib>Strowitzki, Moritz J.</creatorcontrib><creatorcontrib>Büchler, Markus W.</creatorcontrib><creatorcontrib>Ulrich, Alexis</creatorcontrib><creatorcontrib>Schneider, Martin</creatorcontrib><title>Prognostic indicators lose their value with repeated resection of colorectal liver metastases</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>The liver is the most common site of colorectal liver metastases (CRLM) and surgical resection improves overall survival in selected patients. Here, we investigate outcomes and relevant prognostic factors after repeated hepatic resections for CRLM.
From a prospective database, 578 patients who underwent 788 resections of colorectal liver metastases were included into this study. In total, 169 patients underwent a second and 41 patients had a third operation due to intrahepatic metastatic recurrence. Univariate and multivariate analyses were performed to determine prognostic risk factors.
5-year overall survival was 36.7% (95% CI: 30.2%; 43.2%) and 10-year survival was 20.3% (95% CI: 7.6%; 33.0%) in patients undergoing single resection. In patients undergoing a second or third resection, 5- and 10-year survival rates were 56.6% (95% CI: 45.0%; 68.2%) and 21.9% (95% CI: 6.8%; 37.0%) or 53.2% (95% CI: 32.4%; 74.0%) and 25.4%, respectively. In patients undergoing single resection, established markers (number, size and pattern of CRLM [p = 0.030/0.015/<0.001], R-status [p = 0.001], surgical/medical complications [p = 0.001/0.008], CEA-level [p = 0.001] and Fong-Score [p = 0.02]) were significantly associated with survival. In patients undergoing three resections, the only predictive markers were pT-stage of the primary tumor in univariate analysis (p = 0.013) and metachronous metastasis and medical complications in multivariate analysis (p = 0.001/0.025). The Fong-Score had no predictive value in patients undergoing two (p = 0.08) or three (p = 0.7) resections.
Established prognostic indicators are not applicable in patients undergoing repeated CRLM resection. In a highly-selected group of patients, repeated hepatic resections can be performed safely with favorable long-term outcomes.</description><subject>Aged</subject><subject>Carcinoembryonic Antigen - blood</subject><subject>Colorectal cancer</subject><subject>Colorectal metastases</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fong-Score</subject><subject>Hepatectomy - adverse effects</subject><subject>Humans</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - secondary</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm Staging</subject><subject>Recurrence</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgical oncology</subject><subject>Survival Rate</subject><subject>Tumor Burden</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFqGzEQhkVpqB23L5BD0LGX3Y60K2kFuZSQtAFDckiOQSjSbCKzXjmS7JC3zxo7PRYGZga--WE-Qs4Y1AyY_LWqcZVjzYF1NagaBPtC5kw0vOJMqK9kDqrtKqW7ZkZOc14BgG6U_kZmDTAmBMCcPN6l-DzGXIKjYfTB2RJTpkPMSMsLhkR3dtgifQvlhSbcoC3opyGjKyGONPbUxSGmabUDHcIOE11jsXkqzN_JSW-HjD-OfUEerq_uL_9Wy9s_N5e_l5VrhCyVsNB5odABAucaoe39E9jWI-sl14xxLXnrpGw7yy20vNe9YKBko30rrWwW5Ochd5Pi6xZzMeuQHQ6DHTFus-HQ6U4w1agJ5QfUpZhzwt5sUljb9G4YmL1WszJ7rWav1YAyk9bp6PyYv31ao_938ulxAi4OAE5f7gImk13A0aEPezXGx_C__A9iYYnd</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Schmidt, Thomas</creator><creator>Nienhüser, Henrik</creator><creator>Kuna, Constantin</creator><creator>Klose, Johannes</creator><creator>Strowitzki, Moritz J.</creator><creator>Büchler, Markus W.</creator><creator>Ulrich, Alexis</creator><creator>Schneider, Martin</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7166-3675</orcidid></search><sort><creationdate>201810</creationdate><title>Prognostic indicators lose their value with repeated resection of colorectal liver metastases</title><author>Schmidt, Thomas ; Nienhüser, Henrik ; Kuna, Constantin ; Klose, Johannes ; Strowitzki, Moritz J. ; Büchler, Markus W. ; Ulrich, Alexis ; Schneider, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-5a08d57ec0e0229e04fdb0a4de1f6291129624c6648a2a042f9f5107639d46a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Carcinoembryonic Antigen - blood</topic><topic>Colorectal cancer</topic><topic>Colorectal metastases</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fong-Score</topic><topic>Hepatectomy - adverse effects</topic><topic>Humans</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - secondary</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm Staging</topic><topic>Recurrence</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgical oncology</topic><topic>Survival Rate</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schmidt, Thomas</creatorcontrib><creatorcontrib>Nienhüser, Henrik</creatorcontrib><creatorcontrib>Kuna, Constantin</creatorcontrib><creatorcontrib>Klose, Johannes</creatorcontrib><creatorcontrib>Strowitzki, Moritz J.</creatorcontrib><creatorcontrib>Büchler, Markus W.</creatorcontrib><creatorcontrib>Ulrich, Alexis</creatorcontrib><creatorcontrib>Schneider, Martin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schmidt, Thomas</au><au>Nienhüser, Henrik</au><au>Kuna, Constantin</au><au>Klose, Johannes</au><au>Strowitzki, Moritz J.</au><au>Büchler, Markus W.</au><au>Ulrich, Alexis</au><au>Schneider, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic indicators lose their value with repeated resection of colorectal liver metastases</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2018-10</date><risdate>2018</risdate><volume>44</volume><issue>10</issue><spage>1610</spage><epage>1618</epage><pages>1610-1618</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>The liver is the most common site of colorectal liver metastases (CRLM) and surgical resection improves overall survival in selected patients. Here, we investigate outcomes and relevant prognostic factors after repeated hepatic resections for CRLM.
From a prospective database, 578 patients who underwent 788 resections of colorectal liver metastases were included into this study. In total, 169 patients underwent a second and 41 patients had a third operation due to intrahepatic metastatic recurrence. Univariate and multivariate analyses were performed to determine prognostic risk factors.
5-year overall survival was 36.7% (95% CI: 30.2%; 43.2%) and 10-year survival was 20.3% (95% CI: 7.6%; 33.0%) in patients undergoing single resection. In patients undergoing a second or third resection, 5- and 10-year survival rates were 56.6% (95% CI: 45.0%; 68.2%) and 21.9% (95% CI: 6.8%; 37.0%) or 53.2% (95% CI: 32.4%; 74.0%) and 25.4%, respectively. In patients undergoing single resection, established markers (number, size and pattern of CRLM [p = 0.030/0.015/<0.001], R-status [p = 0.001], surgical/medical complications [p = 0.001/0.008], CEA-level [p = 0.001] and Fong-Score [p = 0.02]) were significantly associated with survival. In patients undergoing three resections, the only predictive markers were pT-stage of the primary tumor in univariate analysis (p = 0.013) and metachronous metastasis and medical complications in multivariate analysis (p = 0.001/0.025). The Fong-Score had no predictive value in patients undergoing two (p = 0.08) or three (p = 0.7) resections.
Established prognostic indicators are not applicable in patients undergoing repeated CRLM resection. In a highly-selected group of patients, repeated hepatic resections can be performed safely with favorable long-term outcomes.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30115500</pmid><doi>10.1016/j.ejso.2018.07.051</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7166-3675</orcidid></addata></record> |
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| subjects | Aged Carcinoembryonic Antigen - blood Colorectal cancer Colorectal metastases Colorectal Neoplasms - pathology Female Follow-Up Studies Fong-Score Hepatectomy - adverse effects Humans Liver Neoplasms - secondary Liver Neoplasms - surgery Liver surgery Male Middle Aged Neoplasm Recurrence, Local - secondary Neoplasm Recurrence, Local - surgery Neoplasm Staging Recurrence Reoperation Retrospective Studies Surgical oncology Survival Rate Tumor Burden |
| title | Prognostic indicators lose their value with repeated resection of colorectal liver metastases |
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