Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis

Eighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.The overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly.Optimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above.Despite recent improvements in the diagnosis and management of colorectal cancer (CRC), which have enabled early detection followed by early treatment, many advanced cases with hepatic or peritoneal metastasis are still encountered. For further improvement of the prognosis of CRC, it is particularly important to prolong the survival of these advanced cases with distant metastasis.Hepatectomy for liver metastasis from colorectal cancer (CRCLM) is recommended as the most effective therapy [1-11]. However, to date, 50% to 75% of patients develop recurrence of the disease after curative resection of CRCLM. Moreover, the cure rate by initial hepatectomy is only 20% to 30% of cases [4-6,12]. Factors associated with recurrence and prognostic d