Clinico-pathological prognostic factors in hematogenously disseminated colorectal cancer

Abstract

Background: Ekberg`s criteria for liver resections (LR) of colorectal cancer liver metastases (CRCLM) have been accepted as a `dogma` and the procedure - as a `gold standard` since 1986. There are many wellknown predictive factors for the early and long-term results in this field of surgery. However, some of them are still a matter of debate.
Aim: Study on the possible prognostic value of some clinical-pathological factors for the early and late results after major LR (≥ 2 segments) of CRCLM.
Material and methods: A total of 143 radical (R0) major LR (≥ 2 segments) of synchronous and metachronous CRCLM were performed between 01.01.20007 - 31.12.2014 in the Clinic of Liver, Biliary, Pancreatic and General Surgery, Tokuda Hospital Sofia. The design of the study was `a single center` and `retrospective`. We analyzed the data with possible predictive value - demography, comorbidity, liver function, ASA group, neoadjuvant chemotherapy, type and characteristics of the surgical procedure, pathological data (T,N,G,H) and time of detection of metastases (synchronous or metachronous). The early postoperative morbidity and mortality rates were compared with these factors looking for correlation. The long-term follow-up period was ≥ 12 months for 86 patients (60.1%).
Results: The early postoperative mortality rate was 2.8% (4 cases) for the whole series. The specific morbidity rates were significantly higher in patients above 65 years of age, with ≥ 3 comorbid conditions, multivisceral resections in cases of synchronous metastases and atypical (non-anatomical) LR. The majority of CRCLM cases were ≥ Т2, N (+) positive and G2-3. Unfavorable prognostic factors were the detection of metachronous lesions earlier than 12 months after a curative previous resection especially on the basis of adequate chemotherapy.
Conclusions: The knowledge on prognostic factors in patients with CRCLM as well as on indications and contraindications helps the correct preoperative judgment on choosing the right and appropriate type and volume of surgical procedures.