Prognostic factors and time-related changes influence results of colorectal liver metastases surgical treatment: A single-center analysis

Table 1 Demographic and preoperative characteristics of the patients n (%)

Characteristics
Total patients	236
Age (yr) (mean, range)	63 (36-81)
Sex (male/female)	153/83
Metachronous metastases (> 3 mo)	88
Synchronous metastases	137
Previous CLM resection	11
Localization of primary tumor
Rectum	71 (30)
Colon	165 (70)
Differentiation of primary tumor
Poor differentiated	32 (14.4)
Moderately differentiated	176 (78.9)
Well differentiated	15 (6.7)
Adjuvant treatment of primary tumor
Chemotherapy	97 (41.1)
Radiotherapy plus chemotherapy	39 (16.5)
Radiotherapy alone	5 (2.1)
No treatment	95 (40.3)
Number of hepatic metastases	2 (1-11)
Bilobar distribution	76 (32.5)
Size of metastases (cm)	3 (0.3-12)
Associated disease	164 (72.2)
Anesthetic risk
ASA I-II	150 (63.6)
ASA III-IV	86 (36.4)
Previous treatment of metastases	62 (27.3)
Preoperative CEA (ng/dL)	10.35 (0.4-3203)
Extrahepatic invasion	11 (4.8)

Table 2 Operative characteristics of the patients n (%)

Characteristics
Intraoperative ultrasonography	92%
Number of metastases (median, range)	2 (0-15)
Extrahepatic invasion	38 (16.1)
Type of resection
Major hepatectomy	51 (21.6)
Minor hepatectomy	66 (28)
Atypical hepatectomy	36 (15.3)
Combined hepatectomy	36 (15.3)
No resection	47 (19.9)
Resection of extrahepatic disease	18 (7.5)
Peritoneal disease	4
Diaphragmatic invasion	4
Local disease (colon/rectum)	4
Hilar lymph node invasion	3
Inferior vena cava invasion	2
Splenectomy	1
Additional procedure	159 (72)
Blood loss (mL) (median, range)	370 (0-2500)
Vascular inflow exclusion	56.8%
Vascular exclusion time (min)	33 (4-128)
Need of transfusion	82 (36.8)
Surgery time (min)	220 (30-420)

Table 3 Postoperative results of patients undergoing curative resection n (%)

Postoperative results
Number of metastases (median, range)	2 (1-18)
Size of metastases (cm) (median, range)	3.25 (0.7-15)
Pathological extrahepatic invasion	22 (12.3)
Margins
> 1 cm	33.5%
< 1 cm	42.3%
Invaded	24.2%
Hospital stay (d)	9 (4-43)
Postoperative mortality	4 (1.7)
Major postoperative morbidity	11 (4.7)
Postoperative treatment	100 (52.9)
Neoplastic recurrence at 1 yr	77 (40.9)

Table 4 Time-related changes by period analysis n (%)

	First period (Jan 1994-Jan 2000)	Second period (Feb 2000-Jan 2006)	P
Patients (male:female)	93 (63:30)	143 (90:53)	NS
Age (yr) (mean, range)	63.9 (40-81)	62.5 (36-81)	NS
1-yr survival rate	88.3%	85.6%	NS
1-yr recurrence rate	38.5%	44%	NS
Anesthetic risk
ASA I-II	60 (64.5)	90 (62.9)	NS
ASA III-IV	33 (35.5)	53 (37.1)	NS
Number nodules	1.77 (1-6)	2.3 (1-11)	0.012
Size of nodules	3.8 (0.8-11)	3 (0.2-12)	NS
Bilobar disease	19 (20.4)	57 (39.9)	0.002
Extrahepatic disease	1 (1.1)	10 (7)	0.03
Preoperative CEA level (ng/dL)	13.5 (0.4-3203)	8.9 (0.6-1715)	0.03
Adjuvant treatment to CLM	13 (14)	49 (34.3)	0.001
Resectability rate	69.9%	86.7%	0.002
Use of intraoperative US	91.3%	92.9%	NS
Concordance of IOUS	56.5%	67.9%	NS
Procedures performed			0.024
Major hepatectomy	23 (35.4)	28 (22.6)
Minor hepatectomy	18 (27.7)	48 (38.7)
Atypical hepatectomy	17 (26.2)	20 (16.1)
Combined hepatectomy	7 (10.8)	28 (22.6)
Operative time (min)	226.7 ± 58.8	251 ± 65.3	0.01
Blood loss (mL)	440 (25-1700)	560 (80-2500)	NS
Need of transfusion	40%	44.7%	NS
Complications rate	32.3%	60.5%	0.001
Minor complications	24.6%	54%	0.001
Major complications	7.7%	5.6%	NS
Postoperative stay (d)	11 (5-34)	9 (4-43)	0.018
Postoperative mortality	1.5%	1.6%	NS
Complementary treatment of CLM	60%	49.2%	NS