Original article Long-term survival following delayed presentation and resection of colorectal liver metastases P. J. Swan, F. K. S. Welsh, K. Chandrakumaran and M. Rees Hepatobiliary Unit, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, UK Correspondence to: Mr M. Rees (e-mail: myrddinrees@btconnect.com) Background: Long-term survival from metastatic colorectal cancer is partly dependent on favourable tumour biology. Large case series have shown improved survival following hepatectomy for colorectal liver metastases (CRLM) in patients diagnosed with metastases more than 12 months after index colorectal surgery (metachronous), compared with those with synchronous metastases. This study investigated whether delayed hepatic resection for CRLM affects long-term survival. Methods: Consecutive patients undergoing hepatic resection for CRLM in a single centre (1987–2007) were grouped according to the timing of hepatectomy relative to index bowel surgery: less than 12 months (synchronous; group 1), 12–36 months (group 2) and more than 36 months (group 3). Cancer-specific survival was calculated using Kaplan–Meier analysis. Results: There were 577 patients (48·0 per cent) in group 1, 467 (38·9 per cent) in group 2 and 158 (13·1 per cent) in group 3. The overall 5-year cancer-specific survival rate after liver surgery was 42·3 per cent, with no difference between groups. However, when measured from the time of primary colorectal surgery, group 3 showed a survival advantage at both 5 and 10 years (94·1 and 47·6 per cent respectively) compared with groups 1 (46·3 and 24·9 per cent) and 2 (57·1 and 35·0 per cent) (P = 0·003). Survival graphs showed a steeper negative gradient from 5 to 10 years for group 3 compared with groups 1 and 2 (−0·80 versus −0·34 and −0·37), indicating an accelerated mortality rate. Conclusion: Patients undergoing delayed liver resection for CRLM have a survival advantage that is lost during long-term follow-up. Presented to the UK Alpine Hepato-Pancreatico-Biliary Meeting, Madonna Di Campiglio, Italy, January 2010 Paper accepted 24 February 2011 Published online 19 May 2011 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.7527 Introduction Colorectal cancer is the third most common malignancy in the UK, with 39 991 new cases registered in 2008 1 . Half of patients with colorectal cancer either present with or develop liver metastases in the course of their disease 2–4 . Hepatic resection for colorectal liver metastases (CRLM) provides the best chance of cure, with case series reporting 5-year survival rates of up to 47 per cent 5 . A number of studies have identified predictors of sur- vival after hepatic resection for CRLM 6–17 . These include primary tumour factors, such as lymph node status and tumour differentiation 6–9,14,15 , and also characteristics of the hepatic metastases, such as size and number of metas- tases and the ability to achieve R0 resection 6–8,10–15 . The presence of extrahepatic disease is universally accepted as a poor prognostic marker 6–8,10,13,15 . How- ever, the impact on survival of the interval between primary presentation and hepatic resection (synchronous versus metachronous disease) is less clear. Most studies have reported that synchronous presentation is a neg- ative predictive factor for long-term survival 6,8,10,14–17 , whereas others have found no difference in survival between patients with early or delayed presentation with CRLM 7,9,11–13 . The primary aim of this study was to clarify the impact of the timing of presentation of hepatic metastases on survival after curative liver resection. The secondary aim was to determine whether long-term outcome for delayed presenters changed over the study period.  2011 British Journal of Surgery Society Ltd British Journal of Surgery 2011; 98: 1309–1317 Published by John Wiley & Sons Ltd Downloaded from https://academic.oup.com/bjs/article/98/9/1309/6150613 by guest on 06 December 2023