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10.1245/s10434-006-9284-5
Annals of Surgical Oncology 14:1143-1150 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Lorenzo Capussotti, MD, Luca Vigano’, MD, Alessandro Ferrero, MD, Roberto Lo Tesoriere, MD, Dario Ribero, MD and Roberto Polastri, MD

Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142 km 3,95 10060 Candiolo, Torino, Italy

Correspondence: Address correspondence and reprint requests to: Lorenzo Capussotti, MD; E-mail: lcapussotti{at}mauriziano.it

Background: Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy.

Methods: The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B).

Results: Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064)

Conclusions: Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.

Key Words: Liver surgery • Colorectal liver metastases • Synchronous liver metastases • Timing of liver resection • Neoadjuvant chemotherapy • Prognostic factors




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S. K. Reddy, T. M. Pawlik, D. Zorzi, A. L. Gleisner, D. Ribero, L. Assumpcao, A. S. Barbas, E. K. Abdalla, M. A. Choti, J.-N. Vauthey, et al.
Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis
Ann. Surg. Oncol., December 1, 2007; 14(12): 3481 - 3491.
[Abstract] [Full Text] [PDF]


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