Evaluation of the Recurrence after Hepatic Resection for Metastatic Colorectal Cancer: A Cohort Study

Abstract

Colorectal cancer is the 3rd leading cause of cancer related deaths in males and females. The liver is the most common site of distant disease in colorectal cancer and approximately 60% of patients will develop liver metastases at some point during the course of their disease. Metastatic disease of the liver was considered a lethal disease. Untreated metastatic colorectal carcinoma has a median survival of 6 to 9 months. Also using chemotherapy in the treatment of multiple colorectal cancer metastases was not so successful with median survival rate of 16.2 months. Surgical resection (hepatectomy) of colorectal liver metastases (CRLM) remains the only potentially curative modality of therapy; thehepatectomy can result in a 5-year survival rate of 35-40% Improvements in surgical technique, imaging and systemic therapy have led to expand the criteria of resectability; actually, the only sure contraindication for hepatic resection in management of multiple colorectal liver metastases is the inability to achieve margin-negative resection while ensuring sufficient hepatic reserve. However, even this contraindication had been challenged by evolving recent modalities used to decrease the tumor size and to increase the future liver remnant helped to expand the population of patients eligible for curative-intent surgery. These modalities such as PVE, two staged operations and neoadjuvant chemotherapy had given the hope for many patients to be candidate for hepatic resection of metastases and so, to be candidate for having good survival rate. This multimodal approach for the management of patients with colorectal liver metastasis has called for the consolidation of the concept of managing through the multidisciplinary teams that consist of variety of specialties acting together to offer those patients the best chance of cure and long-term survival. The improvement in survival is due not only to improvements in surgical techniques and postoperative management but also to selection of patients for resection based on risk factors affecting survival. In this study, we operated upon 44 cases, 21 cases were metachronous and 23 cases were synchronous. The cases were resectable or converted by mentioned above techniques to be resectable. In our study After 12 months, 13 patients (29.5%) developed recurrent malignant disease. At the end of follow up, 6 more casesdeveloped recurrence. The median period of follow up was 18 month.