الفهرس 
LIVER ANATOMYOnly 14 pages are availabe for public view
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Abstract
Background: The aim of this work is to assess the recurrence (primary site and distant metastases) after hepatic resection for metastatic colorectal cancer according to the preoperative prognostic factors, for the selection of patients who may benefit from hepatic resection.
Patients and methods: During the period of August 2009 through August 2013, 44 patients with liver metastases from colorectal cancer underwent hepatic resection at Eldemerdash and Ainshams Specialized Hospitals, Ain Shams Universty.Faculty of Medicine. All 44 patients were regularly followed and monitored for recurrence; disease free survival (DFS) and overall survival (OS), within a median follow up of 18 month after hepatic resection.
In this study we investigated the recurrence, disease free survival (DFS) and overall survival (OS) according to 12 perioperative prognostic risk factors, these factors related to the clinicopathologic variables pertaining to patient characteristics, clinical data and histopathologic finding
The mean age of the whole group was 50.7±12.0 ranging from 24 to 75 years. Twenty-seven patients were males (61.4%) and the remaining 17 females constituted 38.6% of the studied group. At presentation 5 patients (11.4%) had colonic obstruction and 2 patients received perioperative blood transfusion. Preoperatively, 36 patients (81.8%) received chemotherapy; 28 patients (63.6%) responded to chemotherapy. In addition 6 patients (13.6%) had portal vein embolization
Results: Solitary metastatic focus was detected in 18 patients (40.9%). The median number of metastatic foci was 2 (range: 1-7) Only two patients had other metastasis outside the liver where the ovarian metastases were discovered during exploration in both patients;. Histopathological type in all cases was adenocarcinoma. Grade of liver metastasis ; the majority of cases had grade II disease. The median size of overall tumor burden of hepatic metastases was 9 cm ranging from 2 to 15 cm. The median size of the largest tumor focus of hepatic metastases was 5 cm ranging from 2 to 12 cm. Nearly One-half of the cases had right lobe lesions. Lymph node metastasis of the primary colon cancer was present in 25 patients (56.8%). CRLM were synchronous in 23 patients (52.3%), while 21 patients (47.7%) had metachronous CRLM.
Carcinoembryonic antigen (CEA) and Cancer antigen (CA) 19.9 were measured in all patients as a part of preoperative assessment. All patients had elevated serum level of CEA except 2 (4.5%), while 5 patients had CEA serum level > 200 μg/L. CA 19.9 serum level were elevated in 21 patient (47.7%); 8 of them had levels > 200 IU/ml.
Preoperatively, 36 patients (81.8%) received chemotherapy; 28 patients (63.6%) responded to chemotherapy. In addition 6 patients (13.6%) had portal vein embolization
The operation done was major in 34 patients (77.3%). The median number of resected segments was 2 (range: 1-6). Only two patients (4.6%) had positive margins of the resected liver segment. The two patients with extrahepatic metastasis had right and left oophorectomy in addition to hepatic resection
5 factors adversely affecting survival and recurrence after hepatic resection for colorectal liver metastases.These are non response to neoadjuvent chemotherapy. Positive lymph node status of the primary colon tumor and advanced nodal stage,the major hepatic resection (more or equal to 2 segments ), the diameter of the largest tumor>5cm and disease free interval from diagnosis of the primary to discovery of liver metastases< one year.
Conclusion: In the present study, the Disease free survival and recurrence after hepatic resection in patients with preoperative prognostic risk factor 0 (without risk factors), was superior to that in resection patients with 1, 2, 3, 4 or 5 factors respectively and in non resection patient and the 5 factors adversely affecting survival and recurrence after hepatic resection for colorectal liver metastases.These are non response to neoadjuvent chemotherapy. Positive lymph node status of the primary colon tumor and advanced nodal stage,the major hepatic resection (more or equal to 2 segments ), the diameter of the largest tumor>5cm and disease free interval from diagnosis of the primary to discovery of liver metastases< one year.