Liver resection for colorectal metastases in presence of extrahepatic disease

Results from an international multi-institutional analysis

Carlo Pulitanò, Martin Bodingbauer, Luca Aldrighetti, Mechteld C. De Jong, Federico Castillo, Richard D. Schulick, Rowan W. Parks, Michael A. Choti, Stephen J. Wigmore, Thomas Gruenberger, Timothy M. Pawlik

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Abstract

Background: Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis. Methods: From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4%) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Median number of treated CLM was 2 (range, 1-18); most patients had solitary EHD (n = 114; 66.6%) a single anatomic site of EHD (n = 153; 89.4%). The 5-year survival for patients with EHD was 26% compared with 58% for those without EHD (P <0.001). Recurrence was common (84%). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P <0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14% and 7%, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.

Original languageEnglish
Pages (from-to)1380-1388
Number of pages9
JournalAnnals of Surgical Oncology
Volume18
Issue number5
DOIs
Publication statusPublished - May 2011

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Neoplasm Metastasis
Liver
Survival
Recurrence
Multivariate Analysis
Lymph Nodes
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Liver resection for colorectal metastases in presence of extrahepatic disease : Results from an international multi-institutional analysis. / Pulitanò, Carlo; Bodingbauer, Martin; Aldrighetti, Luca; De Jong, Mechteld C.; Castillo, Federico; Schulick, Richard D.; Parks, Rowan W.; Choti, Michael A.; Wigmore, Stephen J.; Gruenberger, Thomas; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 18, No. 5, 05.2011, p. 1380-1388.

Research output: Contribution to journalArticle

Pulitanò, C, Bodingbauer, M, Aldrighetti, L, De Jong, MC, Castillo, F, Schulick, RD, Parks, RW, Choti, MA, Wigmore, SJ, Gruenberger, T & Pawlik, TM 2011, 'Liver resection for colorectal metastases in presence of extrahepatic disease: Results from an international multi-institutional analysis', Annals of Surgical Oncology, vol. 18, no. 5, pp. 1380-1388. https://doi.org/10.1245/s10434-010-1459-4
Pulitanò, Carlo ; Bodingbauer, Martin ; Aldrighetti, Luca ; De Jong, Mechteld C. ; Castillo, Federico ; Schulick, Richard D. ; Parks, Rowan W. ; Choti, Michael A. ; Wigmore, Stephen J. ; Gruenberger, Thomas ; Pawlik, Timothy M. / Liver resection for colorectal metastases in presence of extrahepatic disease : Results from an international multi-institutional analysis. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 5. pp. 1380-1388.
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abstract = "Background: Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis. Methods: From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4{\%}) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Median number of treated CLM was 2 (range, 1-18); most patients had solitary EHD (n = 114; 66.6{\%}) a single anatomic site of EHD (n = 153; 89.4{\%}). The 5-year survival for patients with EHD was 26{\%} compared with 58{\%} for those without EHD (P <0.001). Recurrence was common (84{\%}). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P <0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14{\%} and 7{\%}, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.",
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T1 - Liver resection for colorectal metastases in presence of extrahepatic disease

T2 - Results from an international multi-institutional analysis

AU - Pulitanò, Carlo

AU - Bodingbauer, Martin

AU - Aldrighetti, Luca

AU - De Jong, Mechteld C.

AU - Castillo, Federico

AU - Schulick, Richard D.

AU - Parks, Rowan W.

AU - Choti, Michael A.

AU - Wigmore, Stephen J.

AU - Gruenberger, Thomas

AU - Pawlik, Timothy M.

PY - 2011/5

Y1 - 2011/5

N2 - Background: Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis. Methods: From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4%) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Median number of treated CLM was 2 (range, 1-18); most patients had solitary EHD (n = 114; 66.6%) a single anatomic site of EHD (n = 153; 89.4%). The 5-year survival for patients with EHD was 26% compared with 58% for those without EHD (P <0.001). Recurrence was common (84%). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P <0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14% and 7%, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.

AB - Background: Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis. Methods: From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4%) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Median number of treated CLM was 2 (range, 1-18); most patients had solitary EHD (n = 114; 66.6%) a single anatomic site of EHD (n = 153; 89.4%). The 5-year survival for patients with EHD was 26% compared with 58% for those without EHD (P <0.001). Recurrence was common (84%). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P <0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14% and 7%, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased. Conclusion: Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD.

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