Background Although numerous prognostic factors have been reported for colorectal cancer liver metastasis (CRLM), few studies have reported intraoperative blood loss (IBL) effects on clinical outcome after CRLM resection. Methods We retrospectively evaluated the clinical and histopathological characteristics of 139 patients who underwent liver resection for CRLM. The IBL cutoff volume was calculated using receiver operating characteristic curves. Overall survival (OS) and recurrence free survival (RFS) were assessed using the Kaplan–Meier and Cox regression methods. Results All patients underwent curative resection. The median follow up period was 25.0 months (range, 2.1–88.8). Body mass index (BMI) and CRLM number and tumor size were associated with increased IBL. BMI (P=0.01; 95% CI = 1.3–8.5) and IBL (P<0.01; 95% CI = 1.6–12.5) were independent OSOs predictors. Five factors, including IBL (P=0.02; 95% CI = 1.1–4.1), were significantly related to RFS via multivariate Cox regression analysis. In addition, OSOs and RFS significantly decreased with increasing IBL volumes. The 5-year OSOs of patients with IBL≤250, 250–500, and >500mL were 71%, 33%, and 0%, respectively (P<0.01). RFS of patients within three IBL volumes at the end of the first year were 67%, 38%, and 18%, respectively (P<0.01). Conclusions IBL during CRLM resection is an independent predictor of long term survival and tumor recurrence, and its prognostic value was confirmed by a dose–response relationship.
References
[1]
Younes RN, Rogatko A, Brennan MF (1991) The influence of intraoperative hypotension and perioperative blood transfusion on disease-free survival in patients with complete resection of colorectal liver metastases. Ann Surg 214: 107-113. doi:10.1097/00000658-199108000-00003. PubMed: 1867517.
[2]
Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247: 125-135. doi:10.1097/SLA.0b013e31815aa2c2. PubMed: 18156932.
[3]
Wood CB, Gillis CR, Blumgart LH (1976) A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol 2: 285-288. PubMed: 1009711.
[4]
Wagner JS, Adson MA, Van Heerden JA, Adson MH, Ilstrup DM (1984) The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199: 502-508. doi:10.1097/00000658-198405000-00002. PubMed: 6721600.
[5]
K？hne CH (2010) How to integrate molecular targeted agents in the continuum of care. Ann Oncol 21: vii134-vii139. doi:10.1093/annonc/mdq374. PubMed: 20943606.
[6]
Bokemeyer C, Cutsem EV, Rougier P, Ciardiello F, Heeger S et al. (2012) Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: Pooled analysis of the CRYSTAL and OPUS randomised clinical trials. Eur J Cancer (Oxf, England: 1990 48: 1466-1475. PubMed: 22446022.
[7]
Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A et al. (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241: 714-722. discussion: 15849507.
[8]
Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, et al. (2004) Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 240: 438-450; discussion: 15319715. PubMed: 15319715.
[9]
Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R et al. (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239: 817-825; discussion: 15166961.
[10]
Katz SC, Shia J, Liau KH, Gonen M, Ruo L et al. (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249: 617-623. doi:10.1097/SLA.0b013e31819ed22f. PubMed: 19300227.
[11]
Qiu HB, Zhang LY, Zeng ZL, Wang ZQ, Luo HY et al. (2011) HBV infection decreases risk of liver metastasis in patients with colorectal cancer: A cohort study. World J Gastroenterol 17: 804-808. doi:10.3748/wjg.v17.i6.804. PubMed: 21390153.
[12]
Lok AS, McMahon BJ (2007) Chronic hepatitis B. Hepatology 45: 507-539. doi:10.1002/hep.21513. PubMed: 17256718.
[13]
Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P et al. (2007) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25: 4575-4580. doi:10.1200/JCO.2007.11.0833. PubMed: 17925551.
[14]
Quan D, Gallinger S, Nhan C, Auer RA, Biagi JJ et al. (2012) The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: a systematic review. Surgery 151: 860-870. doi:10.1016/j.surg.2011.12.018. PubMed: 22316439.
[15]
Yan TD, Sim J, Black D, Niu R, Morris DL (2007) Systematic review on safety and efficacy of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma. Ann Surg Oncol 14: 2069-2077. doi:10.1245/s10434-007-9388-6. PubMed: 17440785.
[16]
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230: 309-321; discussion: 10493478.
[17]
Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K et al. (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 77: 1254-1262. doi:10.1002/(SICI)1097-0142(19960401)77:7. PubMed: 8608500.
[18]
Achavanuntakul K, Charoenkwan K (2012) Factors affecting operative blood loss from open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer. Arch Gynecol Obstet 286: 1001-1005. doi:10.1007/s00404-012-2387-2. PubMed: 22622853.
[19]
Busch OR, Hop WC, Hoynck van Papendrecht MA, Marquet RL, Jeekel J (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328: 1372-1376. doi:10.1056/NEJM199305133281902. PubMed: 8292113.
[20]
Acheson AG, Brookes MJ, Spahn DR (2012) Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg 256: 235-244. doi:10.1097/SLA.0b013e31825b35d5. PubMed: 22791100.
[21]
Tartter PI (1992) The association of perioperative blood transfusion with colorectal cancer recurrence. Ann Surg 216: 633-638. doi:10.1097/00000658-199212000-00004. PubMed: 1466616.
[22]
Abraham E, Chang YH (1984) Effects of hemorrhage on inflammatory response. Arch Surg 119: 1154-1157. doi:10.1001/archsurg.1984.01390220040009. PubMed: 6477101.
[23]
Abraham E, Lee RJ, Chang YH (1986) The role of interleukin 2 in hemorrhage-induced abnormalities of lymphocyte proliferation. Circ Shock 18: 205-213. PubMed: 3486052.
[24]
Leo C, Giaccia AJ, Denko NC (2004) The hypoxic tumor microenvironment and gene expression. Semin Radiat Oncol 14: 207-214. doi:10.1016/j.semradonc.2004.04.007. PubMed: 15254863.
[25]
Reynolds TY, Rockwell S, Glazer PM (1996) Genetic instability induced by the tumor microenvironment. Cancer Res 56: 5754-5757. PubMed: 8971187.
