Synchronous and metachronous colorectal liver metastases: impact of primary tumor location on patterns of recurrence and survival after hepatic resection Colorectal liver surgery and prognosis

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Ingrid Garajova
Rita Balsano
Chiara Tommasi
Raffaele Dalla Valle
Giuseppe Pedrazzi
Matteo Ravaioli
Andrea Spallanzani
Francesco Leonardi
Chiara Santini
Francesco Caputo
Mattia Riefolo
Mario Giuffrida
Fabio Gelsomino


colorectal cancer, liver metastases, hepatectomy, synchronous metastases, metachronous metastases, primary tumor, outcome


Background:Considerable differences in terms of prognosis exist between the right-sided (RCC) and the left-sided colon cancer (LCC). Aim of the work: In this study, we evaluated prognostic implications of primary tumor location (PTL) among patients who underwent curative-intent hepatectomy for synchronous (SM) and metachronous (MM) colorectal liver metastases (CRLM).Methods:The study population included all consecutive patients affected by CRLM scheduled for first liver resection at three Italian oncological centers. Results:A total of 204 patients who underwent CRLM resection were included, 50% with RCC. Synchronous lesions were prevalent (n=133, 65%). Median OS was respectively 40.3 months for SM-RCC, 53.5 months for SM-LCC, 64.5 months for MM-RCC and 81.6 months for MM-LCC. Patients with MM-LCC showed an OS better than patients with SM-RCC (p=0.008) and SM-LCC (p=0.002). PTL had no influence on RFS. RCC group had less recurrences (75% vs 86.5%), though further surgery with curative-intent was possible more in LCC group (29.3% vs 32.5%). Cox proportional hazards model analysis showed that age and the presence of SM vs MM was associated with a significantly higher hazard ratio (HR) for death (HR=1.024; 95%CI=1.005-1.043; p=0.011 and HR=2.010; 95%CI=1.328-3.043; p=0.001, respectively). Conclusions:We confirmed that patients with CRLM and right-sided primary colon cancer experience worse survival after hepatic resection. The timing of metastasis has been revealed as important prognostic factor.


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