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Inicio Cirugía Española (English Edition) Have we improved postoperative and long-term outcomes of liver surgery for color...
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Vol. 102. Issue 5.
Pages 243-251 (May 2024)
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Vol. 102. Issue 5.
Pages 243-251 (May 2024)
Original article
Have we improved postoperative and long-term outcomes of liver surgery for colorectal cancer metastasis? Analysis of 1736 hepatectomies performed over 3 decades in a single center
¿Hemos mejorado los resultados postoperatorios y a largo plazo de la hepatectomía por metástasis de cáncer colorrectal? Análisis de 1.736 hepatectomías realizadas a lo largo de tres décadas en un solo centro
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Kristel Milsa,
Corresponding author
, Laura Lladóa, Josefina López-Domíngueza, Oriana Barriosa, David Leivab, Cristina Santosc, Teresa Serranod, Emilio Ramosa
a Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain
b Servicio de Radiología, Hospital Universitario de Bellvitge, Cataluña, Spain
c Servicio de Oncología, Hospital Universitario de Bellvitge, Cataluña, Spain
d Servicio de Anatomía Patológica, Hospital Universitario de Bellvitge, Cataluña, Spain
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Figures (2)
Tables (3)
Table 1. Comparison between groups of the demographic and clinical characteristics of the patients operated on for CRLM.
Table 2. Long-term overall survival predictors: Kaplan-Meier univariate analysis and Cox multivariate analysis.
Table 3. Predictors of survival by long-term historical periods: multivariate COX analysis.
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Abstract
Introduction

Surgery is the only potentially curative treatment for colorectal cancer liver metastases (CRLM) and its indication and results have varied in the last 30 years.

Methods

All patients operated on for CRLM in our centre from 1990 to 2021 were prospectively collected, establishing 3 subgroups based on the year of the first surgery: group A 1990–1999, group B 2000–2010, group C 2011−2021. Clinical characteristics and the results of survival, recurrence and prognostic factors were compared.

Results

1736 hepatectomies were included (Group A n = 208; Group B n = 770; Group C n = 758). Patients in group C had better survival at 5 and 10 years (A 40.5%/28.2%; B 45.9%/32.2%; C 51.6%/33.1%, p = 0.013), although there were no differences between groups in overall recurrence at 5 and 10 years (A 73%/75.7%; B 67.6%/69.2%, and C 63.9%/66%, p = 0.524), nor in liver recurrence (A 46.4%/48.2%; B 45.8%/48.2%; and C 44.4%/48.4%, p = 0.899). An improvement was observed in median survival after recurrence, being 19 months, 23 months, and 31 months (groups A, B and C respectively). Prognostic factors of long-term survival changed over the 3 study periods. The only ones that remained relevant in the last decade were the presence of >4 liver metastasis, extrahepatic disease at the time of hepatectomy, and intraoperative blood transfusion.

Conclusions

Survival after surgery for CRLM has improved significantly, although this cannot be explained by a reduction in overall and hepatic recurrence, but rather by an improvement in post-recurrence survival. Involvement of the resection margin has lost prognostic value in the last decade.

Keywords:
Liver surgery
Liver metastases
Survival
Prognostic factors
Resumen
Introducción

La cirugía es el único tratamiento potencialmente curativo de las metástasis hepáticas de cáncer colorrectal (LMCCR) y su indicación y resultados han variado en los últimos 30 años.

Métodos

Todos los pacientes operados por LMCCR en nuestro centro de 1990 a 2021 fueron recogidos prospectivamente, estableciendo 3 subgrupos en función del año de la hepatectomía: grupo A 1990–1999, grupo B 2000–20010, grupo C 2011−2021. Se compararon características clínicas, supervivencia, recidiva y factores pronósticos.

Resultados

Se incluyeron 1736 hepatectomías (Grupo A n = 208; Grupo B n = 770; Grupo C n = 758).En el grupo C mejoró la supervivencia a 5 y 10 años (A: 40,5%/28,2%; B: 45,9%/32,2%; C: 51,6%/33,1%, p = 0.013), sin encontrar diferencias en recidiva global a 5 y 10 años (A: 73%/75,7%; B: 67,6%/69,2%, C: 63,9%/66%, p = 0,524), ni en recidiva hepática (A: 46,4%/48,2%; B: 45,8%/48,2%; C: 44,4%/48,4%, p = 0,899). Se observó una mejoría en la supervivencia mediana tras recidiva, siendo de 19 meses, 23 meses y 31 meses (grupos A, B y C respectivamente). Los factores pronósticos de supervivencia a largo plazo variaron en las 3 épocas, los únicos que mantuvieron relevancia en la última década fueron la presencia de >4 metástasis, la enfermedad extrahepática al momento de la hepatectomía y la transfusión perioperatoria.

Conclusiones

En los pacientes operados por LMCCR la supervivencia ha mejorado de forma significativa, sin que pueda explicarse por una reducción de la recidiva global y hepática, pero si por una mejoría de la supervivencia después de la recidiva. La afectación del margen de resección ha perdido valor pronóstico en la última década.

Palabras clave:
Cirugía hepatica
Metástasis hepaticas
Análisis supervivencia
Factores pronósticos

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