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Improved survival after hepatic resection for metastatic colorectal cancer

Disease-specific survival is improved after hepatic resection for metastatic colorectal cancer, reports the latest issue of the Journal of the American College of Surgeons.

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Dr Michael House and colleagues from Virginia, USA analyzed factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time.

The research team assessed 1600 consecutive patients undergoing hepatic resection for metastatic colorectal cancer between 1985 and 2004.

Patients were grouped into 2 eras according to changes in availability of systemic chemotherapy.

Group 1 spanned from 1985 to 1998, and those in Group 2 were assessed from 1999 to 2004.

The researchers found that there were 1037 patients in Group 1, and 563 in Group 2.

Operative mortality decreased from 3% in Group 1 to 1% in Group 2.

The team found no differences in age, Clinical Risk Score, or number of hepatic metastases between the 2 groups.

Operative mortality decreased from 3% in Group 1 to 1% in Group 2
American College of Surgeons

However, more recently treated patients 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.

The research team found that median and 5-year disease-specific survival were better in Group 2, but median and 5-year recurrence-free survival for all patients were not different.

There was no difference in recurrence-free survival or disease-specific survival for high-risk patients in either Group.

There was a marked improvement in both recurrence-free survival and disease-specific survival for low risk patients.

Dr House's team concluded, “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.”

J Am College  Surg 2010: 210(5): 744-52
05 May 2010

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