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Technical and Biological Factors in Disease-Free Survival After Hepatic Resection for Colorectal Cancer Metastases
Blake Cady, MD;
Michael D. Stone, MD;
William V. McDermott, Jr, MD;
Roger L. Jenkins, MD;
Albert Bothe, Jr, MD;
Philip T. Lavin, PhD;
E. J. Lovett, PhD;
Glenn D. Steele, Jr, MD, PhD
Arch Surg. 1992;127(5):561-569.
Abstract
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• Careful patient selection for hepatic resection of colorectal cancer metastases is essential to improve current poor results. Carcinoembryonic antigen level and number of metastases were significant preoperative prognostic indicators of 5-year disease-free survival in patients selected clinically for hepatic surgery. Surgical margin, weight of hepatic tissue resected, carcinoembryonic antigen level, and flow cytometry were significant postoperative prognostic indicators. Patients with a carcinoembryonic antigen level less than 200 ng/mL, 1-cm surgical margins, and less than 1000 g of liver tissue removed had a greater than 50% estimated 5-year disease-free survival rate. If the metastases were diploid on flow cytometry, an additional survival advantage may have been gained. Inadequate surgical margins led to high rates of liver-only recurrence. Nonhepatic recurrence was unrelated to surgical margins. Intraoperative liver examination by ultrasound during primary colon cancer resection and adjuvant chemotherapy may offer earlier selection of biologically appropriate patients and improved outcome; both recommendations require clinical trials.
(Arch Surg. 1992;127:561-569)
Author Affiliations
From the Division of Surgical Oncology (Drs Cady, Stone, and Steele), Division of Hepatobiliary Surgery (Dr Jenkins), and Department of Surgery (Drs McDermott and Bothe), New England Deaconess Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (Drs Cady, Stone, McDermott, Jenkins, Bothe, Lavin, and Steele); and the University of Southern Maine, Portland (Dr Lovett).
Footnotes
Accepted for publication December 28, 1991.
Presented at the 72nd Annual Meeting of the New England Surgical Society, Quebec City, September 28, 1991.
Reprint requests to New England Deaconess Hospital, Division of Surgical Oncology, 110 Francis St, Suite 2H, Boston, MA 02215 (Dr Cady).
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