Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases

Background and Objectives: Survival analyses after hepatectomy for colorectal liver metastases (CRLM) mostly address tumor-related factors; this study has simultaneously evaluated interventional factors which may be influenced by the surgeon. Methods: Operative and long-term results of 251 consecutive patients undergoing hepatectomy for CRLM between 1992 and 2007 were analyzed. Results: Mortality was 0.8%, morbidity 22.9%, intraoperative blood transfusion rate 23.1% (19.4% with pedicle clamping, 35.0% without clamping, P=0.01), R0-resection 93.6% (2/3 with tumor-free margin >5 mm). The 3-, 5-, 10-year overall and disease-free survival rates were 55.2%, 38.9%, 24.2%, and 37.1%, 28.2%, 25.4%. Univariate analysis: lower survival was related to transfusion requirement, tumor size >5 cm, tumor-free margin <=5 mm, major hepatectomy, R1-resection, multiplicity of CRLM, preoperative CEA >=50 ng/ml. Multivariate analysis: intraoperative transfusion remained the only independent predictor of survival; tumor-free margin <=5mm and multiplicity of CRLM remained independent predictors of disease-free survival within 12 months from hepatectomy; intraoperative transfusion became again the prominent predictor for later recurrences. Conclusions: Two factors may be influenced by the surgeon: bleeding with requirement for blood transfusion (through the protective effect of pedicle clamping) and width of tumor-free surgical margin. These factors have prominent roles on long-term outcomes after hepatectomy for CRLM.