Peter Scherman - Curatively Intended Treatment of Colorectal Liver Metastases - Patient, Primary and Metastatic Pattern as Prognostic Factors
On April 22, Peter Scherman is defending his thesis for Doctor of Medical 91̽»¨ at the Institute of Clinical 91̽»¨s, Sahlgrenska Academy, in research subject of Surgery.
The title of the thesis is: Curatively Intended Treatment of Colorectal Liver Metastases - Patient, Primary and Metastatic Pattern as Prognostic Factors
Background: Resection and/or ablation of colorectal liver metastases (CRLM) is increasingly common and long-term results are improving. In this thesis prognosis of CRLM is studied in a wide perspective, with focus on common clinical factors to consider in preoperative decision making.
Study I-III: Data on radically resected colorectal cancer (CRC) was collected from the Swedish Colorectal Cancer Registry (SCRCR) and patients also treated for CRLM were identified in the Swedish Registry for Liver Cancer (Sweliv). A total of 1325 patients were treated for CRLM with a 5-year relative survival (RS) >50%, also for patients ≥75 years of age. Com-plications from the primary tumor resection and primary tumor characteristics had a large impact on long-term survival after treatment of CRLM. Liver metastasis >20 mm, was associated with increased risk. Number of tumors was of less importance when tumor location was considered. Ablation doubled the risk of death within 5 years in a propensity score analysis. Postoperative complications (POC) were registered for 24% of all patients and were associated with inferior 5-year RS and prolonged hospital stay. Laparoscopic technique lowered the risk for POC.
Study IV-V: The study cohort was based on the randomized COLOFOL trial and included patients with recurrent disease after radically resected CRC. All recurrences within 5 years postoperatively were identified and medical files were scrutinized. Out of 2442 patients, 471 developed any kind of local recurrences or metachronous metastases of which 48% were treated with curative intent. Over 90% of the 235 patients with CRLM were assessed in multidisciplinary tumor boards, 123 (52%) were treated with curative intent with subsequent 5-year overall survival (OS) of 58%. High frequency follow-up after primary tumor resection was a positive prognostic factor for patients with CRLM.
Conclusion: Prognosis of CRLM depend on patient, primary tumor, metastatic pattern, and choice of treatment. After multidisciplinary assessment, high resection rates and long-term survival are achievable.
Above: Cumulative incidence for recurrences after colorectal cancer, first event. Figure 10 from the dissertation
Supervisor: Magnus Rizell
Co-Supervisor: Ingvar Syk, Erik Holmberg
Opponent: Svein Dueland, Oslo universitetssjukhus, Oslo, Norge
Examining Committee: Andreas Muth, Björn Lindkvist och Bobby Tingstedt