Clinical efficacy of liver resection for colorectal liver metastasis in the elderly and prognosis factor analysis / 中华老年医学杂志

Objective:To investigate the clinical efficacy of liver resection for colorectal liver metastases(CRLM)in elderly patients and to analyze factors influencing prognosis.Methods:Clinicopathological and follow-up data of 476 CRLM patients undergone liver resection at our department between January 2000 and August 2016 were retrospectively analyzed.Patients were divided into two groups according their ages: the elderly group(n=112, aged 65 years or older)and the young and middle-aged group(n=364, aged less than 65 years). The safety of the surgical treatment and long-term survival were compared between the two groups.Results:The overall postoperative complication rate was 30.3%.There was no significant difference in postoperative complication rates between the elderly group and the young and middle-aged group(32.1% vs. 29.7%, P=0.618). The mortality within 90 days after surgery was 0.9% in the elderly group and 0.5% in the young and middle-aged group( P=0.688). The 5-year survival rates after surgery were similar between the elderly group and the young and middle-aged group(42.4% vs.44.3%, P=0.672). Multivariate analysis revealed that clinical risk score(CRS)≥3 and RAS mutation were independent risk factors for prognosis. Conclusions:Liver resection is safe in carefully selected elderly CRLM patients and can achieve good long-term outcomes.The CRS and RAS genotype can help predict prognosis in elderly CRLM patients.

Prognosis and risk factors after surgical treatment for colorectal cancer liver metastases / 中华肝胆外科杂志

Objective:To study the impact of surgical treatment on long-term survival in patients with colorectal cancer liver metastases, and to identify the associated risk factors.Methods:The clinical, pathological, and follow-up data were prospectively collected from 781 consecutive patients who underwent hepatic resection for colorectal liver metastases at Hepatopancreatobiliary Surgery Department Ⅰ, Peking Cancer Hospital from Jan 2000 to Nov 2018. There were 497 males and 284 females. The average age was 56.7 years (range 19 to 83 years). The tumor recurrence and survival outcomes on follow-up were analyzed. Survival curves were plotted using the Kplan-Meier mothod. Parametric survival analysis was used to identify predictors of cancer-specific survival.Results:The 1-, 3-, 5- and 10-year overall survival rates were 91.6%, 57.3%, 45.2% and 27.6%, respectively. The median survival was 46 months. The 1-, 3-, 5- and 10-year disease-free survival rates were 45.3%, 26.0%, 22.9%, and 19.5%, respectively. The median disease-free survival was 11 months. On multivariate analysis, 5 risk factors were found to be independent predictors of poor survival: RAS/BRAF gene mutation ( HR=1.650, 95% CI: 1.302-2.089), right-sided colonic primary ( HR=1.361, 95% CI: 1.151-1.667), node-positive primary ( HR=1.660, 95% CI: 1.284-2.146), largest hepatic tumor ≥3 cm ( HR=1.473, 95% CI: 1.157-1.874), and extrahepatic disease ( HR=1.610, 95% CI: 1.294-2.003). Conclusion:Surgery is the key to long-term survival for patients with liver metastases from colorectal cancer. Right colonic primary, RAS/BRAF gene mutation, primary lymph node metastasis, hepatic metastasis with a maximum diameter ≥3 cm and extrahepatic metastasis were factors associated with poor prognosis.

Prognosis of patients with a single compared to multiple colorectal cancer liver metastases after hepatic resection / 中华肝胆外科杂志

Objective:To compare the prognosis of patients with a single compared to multiple colorectal cancer liver metastases (CRLM) after hepatectomy.Methods:The clinical data of 490 patients with colorectal cancer liver metastases who underwent hepatectomy at Department of Hepatopancreatobiliary Surgery Ⅰ, Peking University Cancer Hospital & Institute from January 2006 to December 2016 were retrospectively studied. There were 314 males and 176 females. The median age was 58 years (range 21 to 83 years). There were 200 patients in the single liver metastasis group and 290 patients in the multiple liver metastases group. The tumor recurrence and survival outcomes on follow-up were analyzed. Survival curves were plotted using the Kaplan-Meier method. Both overall survival and disease-free survival between two groups were compared by the log-rank test. Univariate and multivariate Cox regression analyses were used to analyze independent risk factors of overall survival.Results:The 1-, 3-, 5-, 10-year overall survival rates for the single versus the multiple liver metastases groups were 92.5%, 58.6%, 51.0%, 38.8% versus 90.7%, 53.2%, 41.1%, 29.9%. The differences were significant ( P<0.05). The disease-free survival was also significantly better in the single than the multiple groups ( P<0.05). Cox multivariate analysis showed that right-sided primary colonic tumor, preoperative carbohydrate antigen 19-9 level ≥50 U/ml, and RAS mutant were independent factors influencing survival in patients with single liver metastasis; while primary colonic tumor N 1-2, liver metastases diameter ≥5 cm, and RAS mutant were independent factors influencing survival in patients with multiple tumors. If the three independent factors affecting overall survival of patients with multiple liver metastases were assigned 1 point for each factor, the number of patients with scores of 0, 1, 2, and 3 were 50, 145, 84, and 11, respectively. The long-term survival of patients with a low score (0, 1) was similar to those with a single liver metastasis (both P>0.05). However, patients with a high score (2, 3) showed significantly worse long-term survival when compared with patients with a single liver metastasis (both P<0.05). Conclusions:The prognosis of patients with single colorectal liver metastasis was better than those with multiple liver metastases after hepatectomy. For patients with multiple liver metastases with fewer associated risk factors, surgical resection could still result in long-term survival outcomes which were comparable to those patients with a single liver metastasis.

Predictors of early recurrence and long-term survival in patients after resection for colorectal cancer liver metastases with a low-risk on clinical risk score / 中华肝胆外科杂志

Objective:To study the related factors of early recurrence and long-term survival after hepatectomy for patients with colorectal cancer liver metastases (CRLM) with a low-risk on clinical risk score (CRS).Methods:The clinicopathological data of 983 consecutive patients with CRLM who underwent liver resection at Department of Hepatopanereatobiliary Surgery Ⅰ, Peking University Cancer Hospital & Institute between January 2000 and November 2018 were studied retrospectively. A total of 420 patients with a CRS of 0-2 met the inclusion criteria of this study. There were 272 males and 148 females, aged from 21 to 83 years, with a median age 59 years. Univariate and multivariate logistic regression analyses were performed to identify the related factors associated with early recurrence. Survival curves were generated by the Kaplan-Meier method and compared by the log-rank test.Results:Of 420 patients, 272(64.8%) patients developed recurrence, with 163 patients developing early recurrence. Multivariate analysis revealed synchronous liver metastasis ( OR=1.587, 95% CI: 1.021-2.467), number of liver metastases ≥3( OR=1.904, 95% CI: 1.091-3.324) and RAS mutation ( OR=1.774, 95% CI: 1.157-2.270) were independent risk factors of early recurrence. The 5-year overall survival of patients with early recurrence was significantly lower than those with non-early recurrence (33.4% vs 71.1%, P<0.05). For the 163 patients with early recurrence, 41(25.2%) underwent repeat liver resection. When compared with the remaining 122(74.8%) patients who underwent non-resectional treatment, these 41 patients had a significantly higher 5-year overall survival rate (63.5% vs 21.1%, P<0.05). Conclusions:In patients with colorectal cancer liver metastases with a low risk on CRS, the independent risk factors for early recurrence were synchronous liver metastasis, number of liver metastases ≥3, and RAS mutation. Re-resection of early recurrent disease achieved better survival outcomes.

Precise evaluation of biological behavior for colorectal cancer liver metastases / 中华肝胆外科杂志

The incidence of colorectal cancer liver metastases (CRLM) has been gradually increased in recent years. Surgical resection is the most important treatment method for CRLM patients, but the recurrence rate was as high as 60%-70% after surgical resection. Therefore, it is very important to clarify the high-risk prognostic factors for tumor recurrence in patients with CRLM after surgery. Based on the prognostic factors we can accurately evaluate the biological behavior of each patient before surgery and select suitable preoperative chemotherapy regimen, timing and method of localized treatment for them. Thereby the survival benefit from surgical resection of those patients could be maximized. In this article we discussed several important factors affecting the tumor recurrence and survival of patients with CRLM undergoing surgical resection, including clinical risk factor score, preoperative chemotherapy response, the genetic status and the primary tumor location, and explain in detail.

Impact of mutant RAS on prognosis of patients after hepatic resection for colorectal cancer liver metastases / 中华肝胆外科杂志

Objective To study the impact of RAS status on prognosis of patients after liver resection for colorectal cancer liver metastases (CRLM).Methods The data of 545 consecutive CRLM patients who underwent liver resection at the Hepatopancreatobiliary Surgery Department I,Peking University Cancer Hospital between January 1st,2008 and December 31st,2016,were retrospectively reviewed.According to the inclusion and exclusion criteria,356 patients were eventually included into this study.There were 232 males and 124 females,with ages ranging from 21 to 83 years.The clinical and follow-up data of patients with wild-type and mutant RAS were compared.Survival was estimated by the Kaplan-Meier method,and the difference was compared by the log-rank test.Factors influencing survival of these patients were assessed by univariate and multivariate Cox regression analyses.Results There were 247 patients with wild-type RAS and 109 patients with mutant RAS,respectively.The median overall survival of patients with wild-type and mutant RAS were 74 and 30 months respectively.Compared with mutant RAS patients,wild-type RAS patients had significantly better cumulative survival and disease free survival rates (both P ＜ 0.05).Multivariate Cox regression analyses revealed disease free interval from primary to metastases ≤ 12 months (HR =1.673,95％ CI:1.016-2.637),largest hepatic tumor diameter ＞ 5 cm (HR =1.717,95 ％ CI:1.102-2.637),and mutant RAS (HR =1.836,95％ CI:1.322-2.550) were independent risk factors for patients with colorectal cancer liver metastases after hepatic resection.Conclusion Mutant RAS was a poor prognostic factor of survival after liver resection in CRLM patients

Perioperative chemotherapy in patients with colorectal cancer liver metastasis / 中华胃肠外科杂志

The incidence of colorectal cancer liver metastasis (CRLM) increased gradually in recent years. Surgical resection is the most important treatment for CRLM patients to obtain long-term survival, with a 5-year survival rate of about 50%. However, only 20% of the CRLM patients are initially resectable. The recurrence rate after surgery is more than 70%. Perioperative chemotherapy has been widely used with the development of effective chemotherapy regimens and targeted therapies. For patients with initially resectable liver metastases, perioperative chemotherapy may help reduce recurrence and prolong survival. For patients with unresectable liver metastases, conversion chemotherapy with high efficiency provides opportunity for radical resection. However, CRLM is a disease with high heterogeneity and with many factors influencing prognosis, and there is a lack of large-scale prospective clinical trial evidence in many problems. Hence there are still many controversies in the clinical practice of perioperative chemotherapy, including whether chemotherapy alone is the best preoperative treatment for resectable CRLM, whether preoperative chemotherapy combined with targeted therapy is superior to chemotherapy alone, who can benefit most from preoperative chemotherapy combined with targeted therapy, who are the exact patients suitable for conversion therapy, how to choose the best first-line conversion therapy. Here we discuss the current status of research on perioperative chemotherapy in three aspects: neoadjuvant chemotherapy, conversion therapy and adjuvant chemotherapy. We also emphasized the importance of multidisciplinary team during the treatment process to give patients individualized therapy considering their specific conditions.

Rethinking of the conversion therapy in colorectal cancer patients with liver metastasis / 中华肿瘤杂志

The incidence of colorectal cancer liver metastasis (CRLM) has gradually increased in recent years. Surgical resection is the main method to achieve long-term survival for patients with CRLM. However, only 20% of these patients have the chance to undergo surgical resection. If the unresectable metastases can be converted to resectable ones by effective conversion therapy, the 5-year survival rate of patients received liver resection can exceed to 30%, which is significantly better than palliative treatment. Therefore, for patients who are initially unresectable, rationally developing a conversion therapy strategy to convert the initial unresectable CRLM into resectable ones is the key to improve the long-term survival of CRLM patients. However, there are still many controversies in clinical practice. In this article, we discuss three critical issues related to the conversion therapy for CRLM based on previous related researches and our experience, including the applicable population of conversion therapy, how to choose a conversion regime and the recognition and treatment of disappeared lesions after chemotherapy.

Effect of tumor number on the survival of patients of colorectal cancer liver metastases undergoing hepatic resection / 中华普通外科杂志

Objective To analyze the effect of tumor number on the survival of patients with colorectal liver metastases (CRLM) undergoing hepatic resection and the definition of oligometastases.Methods Clinicopathological data of patients with colorectal liver-only metastases undergoing liver resection from our database were retrospectively analyzed.Results Of all 377 patients,the median number of hepatic tumor was 2.The 5-year disease free survival rate was 24.1％.The 5-year overall survival rate was 39.8％.Survival of oligometastatic patients was not significantly different from non-oligometastatic patients (x2 =3.037,P =0.081).Survival of patients with 6-10 hepatic tumors was similar to patients with 1-5 tumors.However,survival of patients with more than 10 tumors was significantly worse than patients with liver tumor less than 10(x2 =5.386,P =0.020).In multivariate analysis,number of liver tumor,primary node status,largest hepatic tumor and gender are independent predictors of overall survival.Conclusions The number of liver tumor was an independent predictor of overall survival.The cut-off number of oligometastatic disease should be 10.

Association between A-kinase anchor proteins 12 methylation and recurrence of hepatocellular carcinoma / 中华预防医学杂志

Objective@#To study the association between the AKAP12 promoter methylation and recurrence of hepatocellular carcinoma.@*Methods@#A total of 142 primary liver cancer patients underwent surgery in department of Hepatobiliary surgery in Peking University Cancer Hospital from 2003 to 2009 were selected as subjects in the survey; with the inclusion criteria as hepatocellular carcinoma, no cancer cells were observed in the surgical margin(SM) samples. All patients had neither lymph nor distant metastasis at the time of surgery, and receiving complete follow-up data for at least 3 years. By the end of May 2014, a total of 75 patients had relapsed of whom 71 died and there were no lost. All samples were acquired from the frozen surgical tissues. Genomic DNA was extracted using phenol/chloroform method and performed bisulfite modification following with polymerase chain reaction (PCR). AKAP12 methylation in hepatoma and the corresponding SM samples from 142 patients was determined by denature high-performance liquid chromatography (DHPLC) and bisulfite clone sequencing. Kaplan-Meier and Cox proportion hazard regression model were used to identify the factors related to the survival time.@*Results@#In 142 cases, 125 patients (88.0%) were male and 17 (12.0%) cases were female. The median age was 52.5 years, ranging from 34 years to 76 years. AKAP12 methylation-positive rate was significantly higher in hepatomas than SMs (54.9% vs. 10.2%, P<0.001). Patients with AKAP12 methylation-positive had less risk of the recurrence (HR=0.62, 95%CI: 0.39-0.99); with tumor diameter more than 5 cm (HR=1.53, 95%CI: 1.00-2.50),portal vein invasion(HR=4.53, 95% CI:2.69-7.64) increased the recurrence risk. Moreover, portal vein invasion had a higher risk of death (HR=2.98, 95% CI: 1.73-4.98).@*Conclusion@#There was significant association between AKAP12 DNA methylation and low risk of recurrence and long progression-free survival of hepatocellular carcinoma patients.

Clinical analysis and treatment strategies for post-hepatectomy haemorrhage / 中华肝胆外科杂志

Objective To analyze the clinical data of patients with post-hepatectomy haemorrhage (PHH) and to discuss the treatment strategies.Method The clinicopathologic data of patients with PHH between 2005-2014 in the HPB Surgery Ward I,Peking University Cancer Hospital,were studied retrospectively.Results In the study period of 10 years,25 of 1 548 patients who underwent hepatectomy suffered from PHH,and 76％ (19/25) of these patients had underlying liver diseases.The common surgical operations followed by PHH were right hemihepatectomy (11/25),and segment Ⅶ/Ⅷ resection (8/25).The median time for PHH to be diagnosed was 27 h,and the median time from diagnosis of postoperative bleeding to reoperation or intervention was 3.5 h.Using the classification of PHH by the International Study Group of Liver Surgery (ISGLS),there were 1 patient in grade A,16 patients in grade B,and 8 patients in grade C.The perioperative mortality of PHH was 8％ (2/25).The most common bleeding site was from the hepatic artery.Conclusions PHH is a serious complication after liver resection,with low occurrence but high mortality.Most patients with PHH can be managed by conservative treatment.Emergency reoperation is required when instability in vital signs appears.Careful evaluation before operation,strict hemostasis during operation,and close monitoring after operation can effectively reduce the incidence and mortality of PHH.

A survival analysis of primary duodenal carcinoma after radical resection / 中华普通外科杂志

Objective To investigate survival for primary duodenal carcinoma patients after radical resection and identify risk factors associated with overall survival.Methods Data of 51 patients with primary duodenal carcinomas who underwent radical resection between December 2003 and December 2012 at Beijing Cancer Hospital were included.Survival analysis was drawn by Kaplan-Meier method,univariate and multivariate analyses were performed to identify variables associated with survival after resection by COX regression model.Results The median overall survival time was 67 months,and the median disease-free time was 40 months,1-,2-and 3-year overall survival rates were 88％,84％ and 67％,respectively.Multivariate analysis revealed that regional lymph-node positive (P =0.032) and CA199 ＞ 37 U/ml (P =0.037) were independent risk factors of patients' overall survival.Conclusions Radical resection improves survival for primary duodenal carcinoma patients.Regional lymph-node positive and CA199 ＞37 U/ml were the most important risk factors of patients'overall survival.

Simultaneous versus staged resection for synchronous rectal cancer liver metastasis / 中国肿瘤临床

Objective:To compare the safety and long-term survival of patients with synchronous rectal cancer liver metastasis, who received either simultaneous or staged resection to treat primary tumor and liver metastases. Methods:Clinicopathologic and peri-operative data were collected retrospectively from 54 patients with synchronous rectal cancer liver metastasis, who received both prima-ry and liver resections between January 2000 and April 2015 at Peking University Cancer Hospital. Routine follow-up was conducted. The safety and long-term survival of 19 patients who underwent simultaneous resection were compared with those of 35 patients who received staged resection. Results:The clinicopathologic data between the two groups were comparable. Postoperative Clavien-Dindo grades 1, 2, 3, and 4 complications were 10.5%(2/19), 31.6%(6/19), 5.3%(1/19), and 10.5%(2/19) for the simultaneous group, respec-tively, and 8.6%(3/35), 17.1%(6/35), 25.7%(9/35), and 0%(0/35) for the staged group correspondingly, which were not significantly different (P=0.093). However, the median postoperative hospital stay of the simultaneous group was significantly shorter than that of the staged group (14 days versus 25 days, P<0.001). The median postoperative overall survival (OS) and disease-free survival (DFS) be-tween these groups were not significantly different [not reached versus 39 months for OS, respectively (P=0.649);10 months versus 10 months for DFS, respectively (P=0.827)]. Conclusion:The postoperative complications in simultaneous resection group were not sig-nificantly increased compared with those in staged resection group for synchronous rectal cancer liver metastasis. The long-term results among the groups were similar.

Surgical treatment of colorectal cancer liver metastasis / 中国肿瘤临床

Surgical resection is currently the only cure treatment for colorectal carcinoma liver metastasis (CRLM). The efficien-cy of surgical resection has improved with the development of systemic chemotherapy and targeted drugs and the application of hepatic arterial infusion chemotherapy in recent years. The number of patients benefiting from surgery has gradually increased. The progression of surgical techniques such as radiofrequency ablation and staged hepatectomy provides chances of cure for patients with CRLM. Multi-disciplinary team creates the opportunity of individual diagnosis and treatment for growing number of patients with CRLM, which, in turn, promotes the treatment of CRLM to a more precise future.

Prognostic evaluation of clinical scoring systems for patients undergoing resection of colorectal cancer liver metastases / 中华肝胆外科杂志

Objective To identify the risk factors associated with overall survival (OS) for patients undergoing partial hepatectomy for colorectal liver metastases,and to assess the predictive values of five published scoring systems in an independent patient cohort for the purpose of external validation.Methods The clinical,pathologic,and complete follow-up data were prospectively collected from 303 consecutive patients who underwent primary hepatic resection for colorectal liver metastases at the Beijing Cancer Hospital from January 2000 to Aug 2014.The predictive values of the Nordlinger score,the Memorial Sloan-Kettering Cancer Center (MSKCC) score,the Iwatsuki score,the Basingstoke index,and the Konopke scoring system were assessed in this patient set.The clinical and pathologic parameters were further analyzed using univariate and multivariate analyses.Results The 1-,3-and 5-year overall survival were 89.2％,50.8％ and 38.6％,respectively.The median survival time was 37 months.Two risk factors were found to be independent predictors of poor overall survival:the N stage of the primary tumor,and a carcinoembyonic antigen level ＞ 30 μg/L.The MSKCC score had the best independent predictive power for survival when compared with the other 4 prognostic systems (C-index:0.903).Conclusion In our patient cohort,the MSKCC score was the best staging system in predicting survival.

Risk factor analysis of early recurrence after resection of colorectal liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the role of repeat liver resection in colorectal liver metastasis (CRLM) with early recurrence and to analyze the risk factors of early recurrence.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 303 CRLM patients undergoing liver resection in our department between January 2000 and August 2014 were analyzed retrospectively. The 5-year overall survivals between early recurrence(within postoperative 1 year) and non-early recurrence were compared. The impact of repeat liver resection on 5-year survival of early recurrence was analyzed. Clinicopathological features which might be associated with early recurrence were investigated using univariate and multivariate analyses.</p><p><b>RESULTS</b>Among 303 patients, 192(63.4%) patients had recurrence, including 145 patients of early recurrence and 47 of non-early recurrence. The 5-year overall survival of early recurrence patients was significantly lower compared with non-early recurrence ones(16.0% vs. 63.9%, P=0.000). Among 145 early recurrence patients, 80 were evaluated as resectable, of whom 22 received repeat liver resection. Compared with other 58 patients receiving conservative treatment, above 22 patients receiving repeat liver resection had a significantly higher 5-year overall survival(27.1% vs. 0%, P=0.033). Multivariate analysis revealed T-stage of primary tumor, lymph node metastasis, and larger size(> 5 cm) of metastatic liver focus were independent risk factors of early recurrence, and good efficacy of neo-adjuvant chemotherapy was independent protective factor of early recurrence(all P<0.05). Repeat liver resection was associated with better long-term survival.</p><p><b>CONCLUSIONS</b>The prognosis of early recurrence after liver resection in CRLM patients is poor, while repeat resection for resectable lesions in recurrence patients can obviously prolong the survival. For those with late T-stage, lymph node metastasis, and larger metastatic liver focus, actively preoperative neo-adjuvant chemotherapy should be considered.</p>

Impact of overweight on postoperative complications and oncological outcome after radical hepatectomy for metastatic colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between overweight and postoperative complications and prognosis after radical hepatectomy for colorectal liver metastasis (CRLM).</p><p><b>METHODS</b>A total of 192 patients who underwent hepatectomy for colorectal liver metastases between January 2000 and March 2012 were eligible for the study. We retrospectively summarized their clinicopathological data, BMI index and postoperative complications, and investigated the relation between these data and complications and prognosis.</p><p><b>RESULTS</b>Of the 192 patients, 109 cases were classified as overweight with a BMI ≥24 and 83 patients were classified as non-overweight with a BMI <24. Seventy-five complications occurred in 68 of the 192 patients (35.4%) who underwent hepatectomy. Surgical complications (P=0.428), operation time (P=0.837), and blood loss (P=0.272) were not statistically significantly associated with BMI. 173 patients were included to analyze the influence of overweight on oncologic outcome. The median survival for the overweight patients was 59 months, while that of non-overweight patients was 31 months (P=0.016). The overweight patients had a longer OS assessed by both univariate analysis (P=0.016) and multivariate analysis (P=0.031). However, no statistical differences in disease-free survival (DFS) were detected between the overweight and non-overweight groups (P=0.058).</p><p><b>CONCLUSIONS</b>Overweight is not independently associated with an increasing complication rate. BMI does not significantly affect the CRLM-DFS, and high BMI patients might have a better overall survival.</p>

Impact of postoperative complications on survival after hepatic resection for metastatic colorectal cancer patients / 中华普通外科杂志

Objective To evaluate the correlation between postoperative complications and prognosis after radical hepatic resection for colorectal liver metastasis (CRLM).Methods We retrospectively summarized patients' clinicopathological data and postoperative complications.Postoperative complications were graded using Dindo-Clavien system of classification.Then we investigate the relation between these data and prognosis.Results One hundred and seventy-three patients were recruited.Postoperative complications developed in 59 (34.1％) cases.37 patients had minor complications and 22 patients had major complications.On univariate (x2 =8.106,P =0.004) and multivariate analysis (x2 =8.006,P =0.005),complication was an independent predictor of overall survival (OS).However,in a subgroup of patients with minor compications,morbidity was not associated with a significant reduction in both OS (x2 =3.199,P =0.074) and disease-free survival (x2 =1.313,P =0.252).Conclusions Postoperative complications are an independent factor for long-term outcomes after hepatic resection for CRLM.

Prognostic significance of clinical risk score system after resection of hepatic metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To validate the prognostic significance of Clinical Risk Score (CRS) system proposed by Fong et al. after hepatectomy of liver metastasis from colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data were collected retrospectively from 294 patients with hepatic metastases from colorectal cancer who received liver resection between January 2000 and August 2014 in Peking University Cancer Hospital. Routine follow-up was done by outpatient interview or telephone. Statistical analysis was conducted to compare the survival of different CRS patients.</p><p><b>RESULTS</b>After a median follow-up of 19 months (2-129 months) for all the 294 patients, the median overall survival and disease-free survival were 35 months and 11 months, respectively. The postoperative 1-, 3- and 5-year overall survival rates were 89.0%, 49.0%, and 35.7%, and the disease-free survival rates were 47.2%, 22.2%, and 18.2%, respectively. For the six different groups with CRS of 0, 1, 2, 3, 4, 5 accordingly, the median overall survival was 64, 59, 33, 35, 17 and 15 months, respectively, showing a significant difference (P=0.002), and the median disease-free survival was 16, 19, 13, 10, 4 and 6 months, respectively, showing also a significant difference (P<0.001). For patients whose CRS were 0-2 and 3-5, the median overall survival was 44 and 33 months, respectively, with a significant difference between them (P=0.022), and the median disease-free survival was 15 and 8 months, respectively, with also a significant difference (P<0.001).</p><p><b>CONCLUSION</b>This CRS system may predict the prognosis for patients with hepatic metastasis from colorectal cancer after hepatectomy, therefore to provide useful reference for making treatment plan for those patients.</p>

Effect of hepatitis on surgical treatment and prognosis of colorectal liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of hepatitis on surgical treatment and prognosis of colorectal liver metastasis(CRLM).</p><p><b>METHODS</b>A retrospective study of medical records of all the patients undergoing operation with colorectal liver metastasis in Peking University Hepatobiliary pancreatic Surgery Ward I from November 2007 to January 2013 was conducted. A total of 175 patients were eligible and divided into two groups: with hepatitis (n=16) or without hepatitis (n=159).</p><p><b>RESULTS</b>Preoperative liver function was similar in these two groups. There were no significant differences in preoperative serum albumin, total bilirubin and prothrombin time between two groups (all P>0.05), except for lower blood platelet in hepatitis group after operation. Major hepatectomy was performed in 37.5% (6/16) and 22.0% (15/159) of two groups respectively (P>0.05). There were also no significant differences in operation time, blood loss, surgical complications and drainage volume (all P>0.05). The median overall survival time was 46 months in hepatitis group and 33 months in non-hepatitis group, and the median disease free time was 8 months in hepatitis group and 10 months in non-hepatitis group (all P>0.05).</p><p><b>CONCLUSION</b>CRLM patients concomitant with hepatitis have adequate liver reserve function for major hepatic resection and have similar prognosis of patients without hepatitis.</p>