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J Korean Cancer Assoc > Volume 30(6); 1998 > Article
Journal of the Korean Cancer Association 1998;30(6): 1175-1183.
Treatment of Hepatic Metastasis of Colorectal Cancer: A Retrospective Analysis of the Outcome in 99 Patients
Jin Cheon Kim, Chang Nam Kim, Chang Sik Yu, Han Il Lee, Sang We Kim, Je Hwan Lee, Woo Kun Kim, Gyeong Hoon Kang, Moon Kyu Lee
1Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
2Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
3Department of Diagnostic Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
4Department of Diagnostic Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
5Department of Surgery, Hyosung Catholic University, College of Medicine, Taegu, Korea.
Among various modalities of treatment in hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to determine important prognostic parameters and to understand clinically significant factors during hepatic resection and follow-up period in patients with hepatic metastasis from colorectal cancer.
Among 1,022 colorectal cancer patients treated at Asan Medical Center from July 1989 to December 1995, 99 patients were found to have liver metastasis at the time of first diagnosis or during follow-up period. These 99 patients were the subject of analysis in this retrospective clinical study. Surgical resection with curative intent was done in 35 patients and chemotherapy in 46 patients. Eighteen patients were with no treatment or misssed during follow-up. Survival rate was analysed according to clinicopathological parameters: sex, age, location of primary tumor, preoperative serum CEA level, TNM staging of primary tumor, number of hepatic metastasis, distribution, synchronous or metachronous lesions, diesase free interval, mode of treatment, type of resection, tumor free resection margin.
Overall survival of the patients with hepatic metastasis was significantly related with numbers of metastasis (<4 vs. >4), distribution (unilobar vs. bilobar), synchronous or metachronous lesions, disease free interval ( < 12 vs. > 12 months), mode of treatment (hepatic resection vs. chemotherapy vs, no treatment, p<0.01. A multivariate analysis showed a significant association of survival with mode of treatment (p<0.01). Survival of patients with hepatic resection was significantly related with resection margin (positive vs. < 1 cm vs. > 1 cm), TNM staging of primary tumor (II vs. III), number of hepatic metastasis (p<0.01), disease free interval (p<0.05). A multivariate analysis showed a significant correlation with survival for tumor free resection margin (p<0.01).
An aggressive approach of hepatic resection in the colorectal liver metastasis will improve survival, if the lesion pennits. In patients with hepatic resection, tumor free resection margin was the most important prognostic parameter by the uniand multivariate analysis. Therefore, every effort should be made to ensure that the clear margin be kept at least more than 1 cm during hepatic resection.
Key words: Colorectal cancer;Hepatic metastasis
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