Risk factors for cancer recurrence or death within 6 months after liver resection in patients with colorectal cancer liver metastasis

Many authors have reported that survival can be prolonged by adequate chemotherapy and molecular target drugs for unresectable or recurrent colorectal cancer liver metastasis (CRCLM). But, surgical resection is still the lone potentially therapeutic treatment for CRCLM. Complete surgical resection combined with chemotherapy can raise 5­year survival rates up to 60% [1]. Despite these excellent results, about 60% of patients who underwent first liver resection for CRCLM will experience recurrence during follow­up [2]. Recurrence is the main cause of death after liver resection for CRCLM [3]. Survival rates are getting worse in patients with repeat liver resection for recurrent hepatic metastasis after previous liver resection. The Purpose: The aim of this study was to find risk factors for early recurrence (ER) and early death (ED) after liver resection for colorectal cancer liver metastasis (CRCLM). Methods: Between May 1990 and December 2011, 279 patients underwent liver resection for CRCLM at Korea University Medical Center. They were assigned to group ER (recurrence within 6 months after liver resection) or group NER (non-ER; no recurrence within 6 months after liver resection) and group ED (death within 6 months after liver resection) or group NED (alive > 6 months after liver resection). Results: The ER group included 30 patients (10.8%) and the NER group included 247 patients (89.2%). The ED group included 18 patients (6.6%) and the NED group included 253 patients (93.4%). Prognostic factors for ER in a univariate analysis were poorly differentiated colorectal cancer (CRC), synchronous metastasis, ≥5 cm of liver mass, ≥50 ng/mL preoperative carcinoembryonic antigen level, positive liver resection margin, and surgery alone without perioperative chemotherapy. Prognostic factors for ED in a univariate analysis were poorly differentiated CRC, positive liver resection margin, and surgery alone without perioperative chemotherapy. Multivariate analysis showed that poorly differentiated CRC, ≥5-cm metastatic tumor size, positive liver resection margin, and surgery alone without perioperative chemotherapy were independent risk factors related to ER. For ED, poorly differentiated CRC, positive liver resection margin, and surgery alone without perioperative chemotherapy were risk factors in multivariate analysis. Conclusion: Complete liver resection with clear resection margin and perioperative chemotherapy should be carefully considered when patients have the following preoperative risk factors: metastatic tumor size ≥ 5 cm and poorly differentiated CRC. [Ann Surg Treat Res 2016;90(5):257-264]