Extended indication criteria of liver resection for colorectal cancer liver metastases.
A single centre comparison of outcome.
T.M. Lodewick, R.M. van Dam, M.C. de Jong, M.A.J. van den Broek, M.H.A. Bemelmans,
S.W.M. Olde Damink, C.H.C Dejong
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
BACKGROUND:
Currently liver resection criteria for colorectal cancer liver metastases (CRCLM) are only
limited by the functional reserve of liver tissue that remains after resection. Strategies to
improve resectabiliy, like induction chemotherapy to reduce hepatic tumor load, staged
resections and preoperative portal vein embolisation to increase future remnant liver volume
and resection combined with tumour ablation, are becoming standard in liver units worldwide.
Due to these strategies more patients become eligible for liver resection of CRCLM and
morbidity and survival after resection may rise. Aim of this study was to compare morbidity
and survival of patients who have undergone liver resection for CRCLM with classic or
extended indication criterria in our centre between January 2000 and December 2010.
METHODS/DESIGN:
Patients with classical (Group I, n=137) and extended indication criteria (Group II, n=98) after
2000 were identified in a prospectively collected database of all patients undergoing liver
surgery for CRCLM at our hospital. Data on co-morbidity, resection margin, short and longterm morbidity, disease free and overall survival were compared. Disease free and five-year
survival rates were calculated and compared according to the Kaplan-Meier Method.
RESULTS:
There were no differences in co-morbidity, ASA classification and age in both groups.
Patients with classic indication criteria for liver surgery had less frequent complications
(29.2% vs 44.8%), a lower in hospital mortality rate (2.9% vs 6.7%) and more R0 resections
(85.4% vs 77.1%). The median disease free survival and overall survival were 22 months (CI
15-29) and 85 months (CI 48-121) respectively in the classic indication group vs 10 months
(CI 9-12) and 35 months (CI 24-46) in the extended indication group (P<0,05). The 5 years
overall survival rate was 60% in the classic vs 21% in the extended indication group (P<0,05)
CONCLUSION:
Modern criteria for liver resection of CRCLM are associated with higher hospital mortality and
complication rates, earlier recurrence and a lower overall survival. Median overall survival for
patients with extended indication criteria is 35 months. The survival benefit compared to
classical criteria or palliative chemotherapy, justifies the relatively high incidence of
perioperative mortality and complications.