Individualized treatment outcomes in colorectal cancer with liver metastasis

Abstract

Aim: Liver metastasis (LM) is the most common cause of death in colorectal cancer (CRC). In cases of recurrent LM, individualized aggressive local treatments are recommended for better survival outcomes. In this study, we aimed to present the health outcomes obtained in a group of highly selected patients with metastatic CRC. Materials and Methods: We retrospectively reviewed the medical records of a total of 45 (28 males, 17 females) patients who were diagnosed with liver-metastatic CRC and underwent surgical treatment between March 2013 and November 2018. Results: The median patient age was 61 years. Thirty-two patients were diagnosed with synchronous metastases, and 21 of these patients underwent synchronous surgery. The median time for metachronous metastases was 18 months. Twenty-three patients developed bilobar metastases, with a median number of 4 (1–18) metastases. Eleven (10 synchronous and 1 metachronous metastasis) patients underwent liver resection without perioperative chemotherapy while the other 34 received perioperative treatment. Parenchymal-sparing liver surgery (metastasectomy/segmentectomy) as performed in 34 patients was the most preferred surgical approach and, again in accordance with the oncological principles, surgery was combined with ablation procedures to treat 31 metastases in 10 patients. The median tumor size and surgical margin width were 35 mm and 3 mm, respectively. Surgical margin positivity was present in 4 patients, of whom only 1 developed local recurrence. In a median time of 12 months, a total of 20 patients developed recurrent LM, and 12 of them underwent secondary surgery. The median survival time was 32 months for all 45 patients and 36 months for the 12 patients who underwent secondary surgery due to recurrences. Discussion and Conclusion: In CRC with LM, aggressive individualized multidisciplinary treatments can provide better survival outcomes in the long term. Synchronous or staged interventions are applicable with an acceptable morbidity and mortality. In patients with recurrent metastasis, parenchymal-sparing procedures should be preferred in order to increase the patient’s chance of repeated surgical treatment. Keywords: hepatectomy; liver resection; metastasectomy; microwave ablation