Survival after Hepatic Resection for Metastatic Colorectal Cancer: Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution

Michael House, Hiromichi Ito, Mithat Gönen, Yuman Fong, Peter J. Allen, Ronald P. DeMatteo, Murray F. Brennan, Leslie H. Blumgart, William R. Jarnagin, Michael I. D'Angelica

Research output: Contribution to journalArticle

266 Citations (Scopus)

Abstract

Background: This study analyzes factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time. Study Design: Sixteen-hundred consecutive patients undergoing hepatic resection for metastatic colorectal cancer between 1985 and 2004 were analyzed retrospectively. Patients were grouped into 2 eras according to changes in availability of systemic chemotherapy: era I, 1985 to 1998; era II, 1999 to 2004. Results: There were 1,037 patients in era I and 563 in era II. Operative mortality decreased from 2.5% in era I to 1% in era II (p = 0.04). There were no differences in age, Clinical Risk Score, or number of hepatic metastases between the 2 groups; however, more recently treated patients (era II) had more lymph node-positive primary tumors, shorter disease-free intervals, more extrahepatic disease, and smaller tumors. Median follow-up was 36 months for all patients and 63 months for survivors. Median and 5-year disease-specific survival (DSS) were better in era II (64 months and 51% versus 43 months and 37%, respectively; p <0.001); but median and 5-year recurrence-free survival (RFS) for all patients were not different (23 months and 33% era II versus 22 months and 27% era I; p = 0.16). There was no difference in RFS or DSS for high-risk (Clinical Risk Score >2, n = 506) patients in either era. There was a marked improvement in both RFS and DSS for low risk (Clinical Risk Score ≤2, n = 1,094) patients. Conclusions: Despite worse clinical and pathologic characteristics, survival but not recurrence rates after hepatic resection for colorectal metastases have improved over time and might be attributable to improvements in patient selection, operative management, and chemotherapy. The improvement in survival over time is largely accounted for by low-risk patients.

Original languageEnglish (US)
Pages (from-to)744-752
Number of pages9
JournalJournal of the American College of Surgeons
Volume210
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

Fingerprint

Colorectal Neoplasms
Survival
Liver
Neoplasm Metastasis
Drug Therapy
Patient Selection
Statistical Factor Analysis
Survivors
Neoplasms
Lymph Nodes
Recurrence
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Survival after Hepatic Resection for Metastatic Colorectal Cancer : Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution. / House, Michael; Ito, Hiromichi; Gönen, Mithat; Fong, Yuman; Allen, Peter J.; DeMatteo, Ronald P.; Brennan, Murray F.; Blumgart, Leslie H.; Jarnagin, William R.; D'Angelica, Michael I.

In: Journal of the American College of Surgeons, Vol. 210, No. 5, 05.2010, p. 744-752.

Research output: Contribution to journalArticle

House, Michael ; Ito, Hiromichi ; Gönen, Mithat ; Fong, Yuman ; Allen, Peter J. ; DeMatteo, Ronald P. ; Brennan, Murray F. ; Blumgart, Leslie H. ; Jarnagin, William R. ; D'Angelica, Michael I. / Survival after Hepatic Resection for Metastatic Colorectal Cancer : Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 5. pp. 744-752.
@article{db5b86c180f440ea80a926c00775cb04,
title = "Survival after Hepatic Resection for Metastatic Colorectal Cancer: Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution",
abstract = "Background: This study analyzes factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time. Study Design: Sixteen-hundred consecutive patients undergoing hepatic resection for metastatic colorectal cancer between 1985 and 2004 were analyzed retrospectively. Patients were grouped into 2 eras according to changes in availability of systemic chemotherapy: era I, 1985 to 1998; era II, 1999 to 2004. Results: There were 1,037 patients in era I and 563 in era II. Operative mortality decreased from 2.5{\%} in era I to 1{\%} in era II (p = 0.04). There were no differences in age, Clinical Risk Score, or number of hepatic metastases between the 2 groups; however, more recently treated patients (era II) had more lymph node-positive primary tumors, shorter disease-free intervals, more extrahepatic disease, and smaller tumors. Median follow-up was 36 months for all patients and 63 months for survivors. Median and 5-year disease-specific survival (DSS) were better in era II (64 months and 51{\%} versus 43 months and 37{\%}, respectively; p <0.001); but median and 5-year recurrence-free survival (RFS) for all patients were not different (23 months and 33{\%} era II versus 22 months and 27{\%} era I; p = 0.16). There was no difference in RFS or DSS for high-risk (Clinical Risk Score >2, n = 506) patients in either era. There was a marked improvement in both RFS and DSS for low risk (Clinical Risk Score ≤2, n = 1,094) patients. Conclusions: Despite worse clinical and pathologic characteristics, survival but not recurrence rates after hepatic resection for colorectal metastases have improved over time and might be attributable to improvements in patient selection, operative management, and chemotherapy. The improvement in survival over time is largely accounted for by low-risk patients.",
author = "Michael House and Hiromichi Ito and Mithat G{\"o}nen and Yuman Fong and Allen, {Peter J.} and DeMatteo, {Ronald P.} and Brennan, {Murray F.} and Blumgart, {Leslie H.} and Jarnagin, {William R.} and D'Angelica, {Michael I.}",
year = "2010",
month = "5",
doi = "10.1016/j.jamcollsurg.2009.12.040",
language = "English (US)",
volume = "210",
pages = "744--752",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Survival after Hepatic Resection for Metastatic Colorectal Cancer

T2 - Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution

AU - House, Michael

AU - Ito, Hiromichi

AU - Gönen, Mithat

AU - Fong, Yuman

AU - Allen, Peter J.

AU - DeMatteo, Ronald P.

AU - Brennan, Murray F.

AU - Blumgart, Leslie H.

AU - Jarnagin, William R.

AU - D'Angelica, Michael I.

PY - 2010/5

Y1 - 2010/5

N2 - Background: This study analyzes factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time. Study Design: Sixteen-hundred consecutive patients undergoing hepatic resection for metastatic colorectal cancer between 1985 and 2004 were analyzed retrospectively. Patients were grouped into 2 eras according to changes in availability of systemic chemotherapy: era I, 1985 to 1998; era II, 1999 to 2004. Results: There were 1,037 patients in era I and 563 in era II. Operative mortality decreased from 2.5% in era I to 1% in era II (p = 0.04). There were no differences in age, Clinical Risk Score, or number of hepatic metastases between the 2 groups; however, more recently treated patients (era II) had more lymph node-positive primary tumors, shorter disease-free intervals, more extrahepatic disease, and smaller tumors. Median follow-up was 36 months for all patients and 63 months for survivors. Median and 5-year disease-specific survival (DSS) were better in era II (64 months and 51% versus 43 months and 37%, respectively; p <0.001); but median and 5-year recurrence-free survival (RFS) for all patients were not different (23 months and 33% era II versus 22 months and 27% era I; p = 0.16). There was no difference in RFS or DSS for high-risk (Clinical Risk Score >2, n = 506) patients in either era. There was a marked improvement in both RFS and DSS for low risk (Clinical Risk Score ≤2, n = 1,094) patients. Conclusions: Despite worse clinical and pathologic characteristics, survival but not recurrence rates after hepatic resection for colorectal metastases have improved over time and might be attributable to improvements in patient selection, operative management, and chemotherapy. The improvement in survival over time is largely accounted for by low-risk patients.

AB - Background: This study analyzes factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time. Study Design: Sixteen-hundred consecutive patients undergoing hepatic resection for metastatic colorectal cancer between 1985 and 2004 were analyzed retrospectively. Patients were grouped into 2 eras according to changes in availability of systemic chemotherapy: era I, 1985 to 1998; era II, 1999 to 2004. Results: There were 1,037 patients in era I and 563 in era II. Operative mortality decreased from 2.5% in era I to 1% in era II (p = 0.04). There were no differences in age, Clinical Risk Score, or number of hepatic metastases between the 2 groups; however, more recently treated patients (era II) had more lymph node-positive primary tumors, shorter disease-free intervals, more extrahepatic disease, and smaller tumors. Median follow-up was 36 months for all patients and 63 months for survivors. Median and 5-year disease-specific survival (DSS) were better in era II (64 months and 51% versus 43 months and 37%, respectively; p <0.001); but median and 5-year recurrence-free survival (RFS) for all patients were not different (23 months and 33% era II versus 22 months and 27% era I; p = 0.16). There was no difference in RFS or DSS for high-risk (Clinical Risk Score >2, n = 506) patients in either era. There was a marked improvement in both RFS and DSS for low risk (Clinical Risk Score ≤2, n = 1,094) patients. Conclusions: Despite worse clinical and pathologic characteristics, survival but not recurrence rates after hepatic resection for colorectal metastases have improved over time and might be attributable to improvements in patient selection, operative management, and chemotherapy. The improvement in survival over time is largely accounted for by low-risk patients.

UR - http://www.scopus.com/inward/record.url?scp=77952300630&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952300630&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2009.12.040

DO - 10.1016/j.jamcollsurg.2009.12.040

M3 - Article

C2 - 20421043

AN - SCOPUS:77952300630

VL - 210

SP - 744

EP - 752

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -