Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity.

BACKGROUND: Liver surgery is the gold-standard treatment of colorectal liver metastases. Five-year survival rates may be inadequate to evaluate surgical outcomes because some patients are alive with recurrence and late recurrences are possible. The aim of this study was to analyze 10-year survival outcome in terms of late recurrence rate and prognostic factors of survival.
METHODS: One hundred twenty-five patients underwent liver resection for colorectal liver metastases between 1985 and 1996. Four patients who experienced postoperative mortality were excluded. The analysis was performed on 121 patients.
RESULTS: Five- and 10-year survival rates were 23.1% and 15.7%, respectively. Nineteen patients were alive 10 years after liver resection and 17 were disease-free (5 after re-resection). Five- and 10-year disease-free survival rates were 17.4% and 14.8%, respectively. In patients with recurrence, re-resection significantly improved survival (P < 0.001); 98% of recurrences occurred within the first 5 years, but 15% of patients disease-free at 5 years developed later recurrence. Multivariate analysis evidenced five independent negative prognostic factors of survival: male sex (P = 0.029), synchronous metastases (P = 0.011), >3 metastases (P < 0.001), metastatic infiltration of nearby structures (P < 0.001), and postoperative morbidity (P < 0.001). In 17 patients without negative prognostic factors the 10-year survival rate was 35.3%.
CONCLUSION: Liver resection for colorectal liver metastases may be curative in more than one-third of patients without negative prognostic factors. Postoperative morbidity significantly worsens long-term outcomes. The risk of recurrence after liver resection is high even after 5 years of follow-up, but re-resection can improve the outcome.