Abstract
Background
Few reports exist on long-term survival after minimally invasive liver surgery (MILS) for colorectal liver metastases (CRLM). No data are available assessing prognostic factors in the era of current modern treatment strategies.
Methods
Between October 2002 and December 2008, 274 consecutive patients were analyzed on an intention-to-treat basis. Open liver surgery (OLS) was performed in 193 patients for a total of 437 metastases, and MILS was performed in 81 patients for 176 metastases. Systemic chemotherapy was administered preoperatively in 173 and postoperatively in 174 patients. The impact of 23 potential prognostic factors on disease-free (DFS) and overall survival (OS) was evaluated using univariable and multivariable Cox regression models.
Results
Postoperative complications were observed in 54 patients after OLS and in 11 after MILS (p = 0.016). The median postoperative length of hospital stay was 9 days after OLS and 5 days after MILS (p < 0.0001). For the entire patient population, the 5 year DFS and OS rates were 29.9 and 59.5%, respectively. No differences in survival between patients treated with MILS and OLS were observed (p = 0.63). In univariable analyses, the number of liver metastases and the overall Fong’s clinical risk score (CRS) were the only two variables that predicted DFS (p ≤ 0.0035) and OS (p ≤ 0.0005). In multivariable analyses, the total CRS was the only independent predictor of both DFS (p = 0.0002) and OS (p = 0.002).
Conclusion
The long-term oncologic outcome of surgically treated patients with CRLM is determined by the Fong’s CRS. Although MILS does not influence long-term survival, it has a beneficial impact on the immediate postoperative clinical outcome.
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References
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318
Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, Lillemoe KD, Yeo CJ, Cameron JL (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766
Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Vauthey JN (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722
Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, Kemeny N, Brennan MF, Blumgart LH, D’Angelica M (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580
Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F (2008) Laparoscopic vs. open liver resection of hepatic neoplasms; comparative analysis of short-term results. Surg Endosc 22:2208–2213
Rocha FG, D’Angelica M (2010) Treatment of liver colorectal metastases: role of laparoscopy, radiofrequency ablation, and microwave coagulation. J Surg Oncol 102:968–974
Nguyen KT, Geller DA (2010) Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol 102:975–977
Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ (2006) Radiofrequency ablation of liver tumours: a systematic review. Arch Surg 141:181–190
Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC (2009) Minimally invasive liver resection for metastatic colorectal cancer. A multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848
Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centres. Ann Surg 250:849–855
Sasaki A, Nitta H, Otsuka K, Takahara T, Nishizuka S, Wakabayashi G (2009) Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 96:274–279
Kazaryan AM, Marangos IP, Røsok BI, Rosseland AR, Villanger O, Fosse E, Mathisen O, Edwin B (2010) Laparoscopic resection of colorectal liver metastases. Surgical and long-term oncologic outcome. Ann Surg 252:1005–1012
Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T (2008) Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol 15:144–157
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:214–215
Lin D, Wei L, Ying Z (1993) Checking the Cox model with cumulative sums of Martingale-based residuals. Biometrika 80:557–572
Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, Blumgart LH, D’Angelica M (2007) The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg 246:295–300
Nuzzo G, Giuliante F, Ardito F, Vellone M, Giovannini I, Federico B, Vecchio FM (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-centre experience. Surgery 143:384–393
De Haas RJ, Wicherts DA, Flores E, Azoulay D, Castaing D, Adam R (2008) R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 248:626–637
Lordan JT, Karanjia ND (2010) ‘Close Shave’ in liver resection for colorectal metastases. Eur J Surg Oncol 36:47–51
Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation. Multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171
Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, Jaeck D, Mirza D, Parks RW, Collette L, Praet M, Bethe U, Van Cutsem E, Scheithauer W, Gruenberger T, EORTC Gastro-Intestinal Tract Cancer Group, Cancer Research UK, Arbeitsgruppe Lebermetastasen und-tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO), Australasian Gastro-Intestinal Trials Group (AGITG), Fédération Francophone de Cancérologie Digestive (FFCD) (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 371:1007–1016
Disclosures
Drs. B. Topal, J. Tiek, H. Prenen, S. Fieuws, E. Van Cutsem, T. Roskams, and R. Aerts have no conflicts of interest or financial ties to disclose.
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Topal, B., Tiek, J., Fieuws, S. et al. Minimally invasive liver surgery for metastases from colorectal cancer: oncologic outcome and prognostic factors. Surg Endosc 26, 2288–2298 (2012). https://doi.org/10.1007/s00464-012-2176-9
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DOI: https://doi.org/10.1007/s00464-012-2176-9