Liu DM, Yang XY, Zheng HH, Chen PM, Zeng SK, Wei YF. Impact of primary colorectal cancer site on surgical outcomes for liver metastases: A retrospective study. World J Gastrointest Surg 2025; 17(11): 111138 [DOI: 10.4240/wjgs.v17.i11.111138]
Corresponding Author of This Article
Yu-Feng Wei, MD, Department of General Surgery, The Affiliated Hospital of Jiangxi University of Chinese Medicine, No. 445 Bayi Avenue, Donghu District, Nanchang 330200, Jiangxi Province, China. wy18070036305@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Liu DM, Yang XY, Zheng HH, Chen PM, Zeng SK, Wei YF. Impact of primary colorectal cancer site on surgical outcomes for liver metastases: A retrospective study. World J Gastrointest Surg 2025; 17(11): 111138 [DOI: 10.4240/wjgs.v17.i11.111138]
Da-Mao Liu, Xian-Yu Yang, Hui-Hua Zheng, Pan-Min Chen, Shu-Kun Zeng, Yu-Feng Wei, Department of General Surgery, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330200, Jiangxi Province, China
Author contributions: Liu DM and Yang XY wrote the initial manuscript draft; Liu DM, Yang XY, and Zheng HH collected and analyzed the clinical data; Liu DM and Wei YF conceived and designed the study; Zheng HH, Chen PM, and Zeng SK critically revised the manuscript for important intellectual content; Chen PM and Zeng SK performed the statistical analysis and created the figures; Wei YF supervised the entire study and provided final approval of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Affiliated Hospital of Jiangxi University of Chinese Medicine (Approval No. JXZYYFS-LL-2025105).
Informed consent statement: This retrospective study was conducted using anonymized clinical data of patients who underwent surgical treatment for colorectal cancer with liver metastases between January 2014 and January 2024 at the Affiliated Hospital of Jiangxi University of Chinese Medicine. The requirement for signed informed consent was formally waived by the Ethics Committee of The Affiliated Hospital of Jiangxi University of Chinese Medicine.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Feng Wei, MD, Department of General Surgery, The Affiliated Hospital of Jiangxi University of Chinese Medicine, No. 445 Bayi Avenue, Donghu District, Nanchang 330200, Jiangxi Province, China. wy18070036305@163.com
Received: July 15, 2025 Revised: August 19, 2025 Accepted: September 25, 2025 Published online: November 27, 2025 Processing time: 132 Days and 18.8 Hours
Abstract
BACKGROUND
Colorectal cancer is a common malignancy with increasing incidence, and 15%-25% of patients develop liver metastases with poor prognosis. Recent evidence suggests that primary tumor location significantly influences embryological origin, anatomical structure, clinical manifestations, and outcomes, yet traditional clinical approaches have treated all colorectal cancer sites as a single entity.
AIM
To investigate how the anatomical origin of primary colorectal tumors influences surgical outcomes in patients presenting with hepatic metastases.
METHODS
This cross-sectional investigation encompassed 178 patients diagnosed with colorectal cancer hepatic metastases who received treatment at our institution between January 2014 and January 2024. Based on postoperative disease progression, participants were stratified into two groups: Those experiencing tumor recurrence (n = 88) vs those without recurrence (n = 90). Demographic and clinical characteristics were systematically compared between groups. Multivariate logistic regression analysis was subsequently applied to variables demonstrating statistical significance, enabling identification of independent predictors of postoperative recurrence in colorectal cancer patients with liver metastases. Additionally, we examined associations between primary tumor location and various prognostic factors, while evaluating recurrence patterns across different anatomical sites during the 12-month postoperative period.
RESULTS
Analysis revealed that right-sided colonic origin (55.68%), presence of nodal involvement (92.05%), elevated D-dimer levels ≥ 180 μg/L, hypoalbuminemia (albumin < 29 g/L), suboptimal or absent neoadjuvant treatment (43.18%), and elevated clinical risk scores (53.41%) constituted independent predictors of postoperative recurrence in hepatic metastatic colorectal cancer. Primary tumor location demonstrated positive associations with lymphatic spread, D-dimer elevation, and clinical risk stratification, while showing inverse relationships with albumin levels and neoadjuvant therapy effectiveness. Among the entire cohort of 178 patients, those with right-sided primary tumors exhibited substantially higher recurrence frequencies at 3-month (53.57%), 6-month (55.17%), and 12-month (55.68%) intervals compared to left-sided colonic primaries (32.14%, 24.14%, 26.14%) and rectal primaries (14.29%, 20.69%, 18.18%), with statistically significant differences observed.
CONCLUSION
Right-sided colonic primary location, lymphatic metastasis, D-dimer elevation, hypoalbuminemia, neoadjuvant therapy response, and clinical risk stratification emerged as significant determinants of postoperative recurrence in patients with colorectal cancer hepatic metastases.
Core Tip: This retrospective study investigates how the primary tumor location in colorectal cancer affects clinical outcomes following liver metastasis resection. Among 178 patients, right-sided colon cancers were associated with significantly higher recurrence rates, postoperative complications, and worse survival compared to left-sided and rectal cancers. Multivariate analysis identified right-sided origin, lymph node metastasis, elevated D-dimer, hypoalbuminemia, poor neoadjuvant response, and high clinical risk scores as independent predictors of recurrence. These findings highlight the prognostic importance of tumor site and support site-specific treatment strategies for patients with colorectal liver metastases to improve surgical safety and long-term outcomes.
