Remnant Liver Ischemia and Cancer-Specific Survival After Resection of Colorectal Liver Metastases

Key Points

  • Postoperative remnant liver ischemia grade ≥ 2 was associated with worse cancer-specific survival after resection of colorectal liver metastases.
  • Remnant liver ischemia grade ≥ 2 was associated with poorer recurrence-free survival.

In a single-center experience reported by Yamashita et al in JAMA Surgery, postoperative remnant liver ischemia of grade ≥ 2 was associated with worse cancer-specific survival after resection of colorectal liver metastases.

Study Details

The retrospective analysis included 202 patients who underwent curative resection for colorectal liver metastases at The University of Texas MD Anderson Cancer Center between January 2008 and December 2014 and had enhanced computed tomography images obtained within 30 days after surgery.

Postoperative remnant liver ischemia was defined as grade 0 (none), 1 (marginal), 2 (partial), 3 (segmental), or 4 (necrotic). Patients had a median age of 56 years, and 42% were female.

Recurrence and Survival

Remnant liver ischemia was grade 0 in 105 patients, grade 1 in 47 patients, grade 2 in 45 patients, grade 3 in 5 patients, and grade 4 in 0 patients. For patients with grade ≥ 2 vs grade ≤ 1 remnant liver ischemia, recurrence-free survival at 3 years was 6.4% vs 39.2% (P < .001), and cancer-specific survival at 5 years was 20.7% vs 63.7% (P < .001).

Largest metastasis of ≥ 3 cm (odds ratio [OR] = 2.74, P = .005), multiple colorectal liver metastases (OR = 2.51, P = .009), and nonanatomic resection (OR = 3.29, P = .002) were associated with remnant liver ischemia of grade ≥ 2. Largest metastasis of ≥ 3 cm (hazard ratio [HR] = 1.70, P = .045), mutant RAS (HR = 2.15, P = .005), and remnant liver ischemia grade ≥ 2 (HR = 2.90, P < .001) wereeach associated with worse cancer-specific survival.

The investigators concluded: “In this study, remnant liver ischemia grade 2 or higher was associated with worse [cancer-specific survival] after resection of [colorectal liver metastases]. High-quality anatomic surgery to minimize [remnant liver ischemia] after resection is essential.”

The study was supported by the National Cancer Institute.

Claudius Conrad, MD, PhD, of the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, is the corresponding author of the JAMA Surgery article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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