Survival after Hepatectomy for Metastatic Colorectal Cancer in the Presence of Resectable Extrahepatic Disease

Background: The presence of extrahepatic disease, bilobar disease or greater than four hepatic lesions were once considered contraindications to hepatectomy for colorectal metastases but are being reconsidered. We reviewed our experience with resection of extrahepatic disease (EHD) at the time of hepatectomy for metastatic colorectal cancer to determine the impact on perioperative and long-term outcome. Methods: The medical records of 441 patients who underwent hepatectomy for colorectal cancer metastases from 1989 to 2010 were reviewed. Demographics, clinicopathologic characteristics, and outcomes were compared between those with and without extrahepatic disease. Overall survival curves were constructed using the Kaplan Meier method and compared with the log rank test. Multivariate analysis using logistic and Cox proportional hazards regression were used to determine predictors of perioperative mortality and longterm survival, respectively. Results: Fifty-nine (13%) patients presented with EHD at the time of hepatectomy. There were no significant differences between patients with and without EHD with regard to age, gender, disease free interval, or the number and distribution of hepatic metastases. Patients with EHD were as likely to undergo complete (i.e. R0) resection as those with isolated liver metastases (59% vs. 74%. p>0.05). Perioperative mortality in the 441 patients was 2.3%. Only increasing number of liver segments resected and perioperative complications were predictive of perioperative mortality by multivariate analysis. Median overall survival was 20.5 months in patients with EHD compared to 35.2 months in patients without EHD (p<0.001). Increasing age, the presence of EHD, bilobar disease, and length of stay in the ICU were significant predictors of decreased overall survival by multivariate analysis. ConclusionDespite similar populations, extrahepatic disease remains a poor prognostic indicator for survival after hepatectomy for colorectal metastasis. Though a low perioperative mortality Corresponding author: Dr. Mark Bloomston Email: [email protected] Published: 03 March 2014 Ibnosina J Med BS 2014;6(2):67-74 Received: 10 October 2013 Accepted: 02 January 2014 This article is available from: http://www.ijmbs.org This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1Division of Surgical Oncology, Department of Surgery, University of Medicine and Dentistry New JerseyNew Jersey Medical School, Newark, New Jersey, USA 2Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA. Chokshi RJ et al Hepatectomy and Extrahepatic Colorectal Metastases www.ijmbs.org ISSN: 1947-489X 68 coupled with median survival of 20.5 months emphasizes the potential of a curative approach to patients with traditionally incurable disease, resection of EHD should be carefully weighed. The presence of resectable extrahepatic disease should not be a contraindication to hepatectomy for colorectal metastases but should be approached cautiously due to its poor prognostic factors.