Resection of Colorectal Carcinoma Liver Metastases: A Population-Based Study in Outcomes and Factors Associated with Recurrent Disease

Objective To assess the hepatic disease-free survival (HDFS) and overall survival (OS) of patients who underwent resection of colorectal cancer liver metastases (CRCLM) in our population, and evaluate what factors are associated with these outcomes. Methods Patients with resected non-mucinous CRCLM between January 2013-February 2020 were retrospectively identified. Dates of diagnosis, surgery, and, if applicable, death were recorded. HDFS and OS were calculated using a census date of 24 September 2022. Separate Cox multivariate regression analyses were performed to evaluate for association between HDFS and OS and the following factors: pre-operative imaging interval (<4 weeks vs. ≥4 weeks); pre-operative imaging modality (CT only vs. MRI+CT); extrahepatic disease at time of hepatectomy (yes vs. no); tumor burden score (TBS, where TBS2 = (largest axial dimension of CRCLM)2 + (number of CRCLM)2); pT and pN; and neoadjuvant chemotherapy. Results 137 subjects (mean age, 61±11 years, 86 males) were included. Associations with recurrent hepatic disease were found with chemotherapy (HR 2.11[95% CI=1.13–3.92]), TBS (HR 1.30[95% CI=1.17–1.45]), MRI+CT (HR 2.12[95% CI=1.29–3.48]), and extrahepatic disease at hepatectomy (HR 2.16[95% CI=1.08–4.35]). For mortality, associations were found with TBS (HR 1.22[95% CI=1.09–1.37]), pT (HR 1.45[95% CI=1.05–2.00]), and extrahepatic disease at hepatectomy (HR 2.10[95% CI=1.31–3.36]). Conclusion In our population, non-imaging related factors TBS, neoadjuvant chemotherapy, pT and presence of extrahepatic disease at time of hepatectomy were associated with HDFS and/or OS. The preoperative imaging interval and use of preoperative MRI were not associated with improved patient outcomes.