Laparoscopic liver resection for colorectal liver metastases — short- and long-term outcomes: A systematic review

Table 7 Prognostic factors for survival in liver resection for colorectal liver metastases

Ref.	Prognostic factor	Affected outcome + influence	HR (95%CI)	P value
Langella et al[52]	Postoperative complications	Worse 3-yr OS	3.804 (1.336-10.832)	0.012
	Multiple metastases		3.421 (1.317-8.890)	0.012
Nomi et al[27]	Synchronous CRLM	Worse OS	1.482 (0.621-2.859)	0.023
	Positive surgical margin		2.342 (1.356-2.912)	0.012
	Node-positive primary tumor	No difference in OS	1.857 (0.712-3.459)	0.382
	Bilobar metastases		1.398 (0.728-2.458)	0.298
	CRLM ≥ 5 cm		6.813 (2.348-4.245)	0.351
Postriganova et al[28]	Resection margin width (< 1 mm, 1-< 3 mm, 3-< 10 mm and ≥ 10 mm)	No difference in length of survival	-	0.988
		No difference in DFS	-	0.978
		No difference in RFS	-	0.913
Tabchouri et al[70]	Node-positive primary tumor	Increased risk of recurrence	1.611 (1.14-2.28)	0.007
	Extrahepatic disease before hepatectomy		1.745 (1.24-2.45)	0.001
	R1 resection		1.648 (1.08-2.52)	0.021
	Age > 70 yr	Worse survival	3.157 (1.10-3.10)	0.021
	Recurrence		4.637 (1.60-6.26)	0.002
Tohme et al[55]	MILS (vs OLR)	Timely initiation of AC	2.23 (1.16-4.31)	0.017
	OLR with postoperative complications (vs MILS without complications)		0.45 (0.23-0.86)	0.017
	Number of lesions (solitary vs multiple)		1.71 (1.14-2.54)	0.009
	Length of stay (> 4 vs ≤ 4 d)		0.64 (0.41-0.99)	0.043
	AC more than 60 d after surgery	Worse RFS		0.05
		Worse OS		0.06
Topal et al[86]	Fong’s CRS	Worse DFS	1.46 (1.19-1.78)	0.0002
	Preoperative systemic chemotherapy		1.70 (1.15-2.52)	0.008
	Male sex	Worse OS	2.54 (1.45-4.45)	0.001
	Interval systemic chemotherapy and surgery for CRLM		1.06 (1.01-1.10)	0.012
	Fong’s CRS		1.49 (1.16-1.91)	0.002
Yue et al[39]	TNM stage of primary tumor (III vs I-II)	Worse OS	1.981 (1.258-3.854)	0.021
	Disease-free interval (< 12 vs ≥ 12 mo)		1.610 (1.378-2.873)	0.015
	Number of metastases (≥3 vs < 3)		1.500 (1.258-1.870)	0.041
	Disease-free interval (< 12 vs ≥ 12 mo)	Worse DFS	1.874 (1.215-2.001)	0.036
	Preoperative CEA levels (≥ 5 vs < 5 ng/mL)		1.740 (1.418-2.108)	0.028
Zeng et al[56]	Disease-free interval (< 36 vs ≥ 36 mo)	5-yr OS	2.9871 (2.012-6.980)	0.009
	Disease-free interval (< 36 vs ≥ 36 mo)	5-yr DFS	2.9501 (1.895-3.562)	0.010
Montalti et al[33]	Lesions located in posterosuperior segments	Worse tumor recurrence	2.4 (1.24-4.61)	0.009
	Blood loss (≥ 1000 mL vs < 1000 mL)		3.2 (1.23-7.99)	0.012
	R1 margins	No difference in OS	1.06 (0.57-3.80)	0.37
	CEA levels (≥ 10 µg/L vs < 10 µg/L)	Worse OS	4.2 (2.02-16.9)	0.001
	Multiple lesions (>2 vs ≤2 lesions)	Increased risk of R1 margins	9.32 (1.14-32.5)	0.037
Cervantes et al[98]	CRLM minimum size <9 mm	Worse RFS	1.6 (1.1-2.4)	< 0.05
		Worse hepatic RFS	1.8 (1.2-3.0)	< 0.05
De Haas et al[99]	Development of adrenal metastases after LR	Worse survival	-	0.020
Jones et al[100]	SUVmean during PET-CT	Insignificant negative effect on OS	1.053 (0.839-1.321)	0.659
	Log(volume of tumor)	Insignificant negative effect on OS	1.699 (0.964-2.993)	0.067
Ratti et al[101]	Right colonic neoplasms	Worse RFS	2.382 (1.46-2.75)	0.042
	T-stage of primary tumor (T3-T4)		1.962 (1.55-3.01)	0.044
	RAS mutation		2.122 (1.33-2.96)	0.039
	CRS > 3		2.572 (1.68-3.65)	0.029
	Absence of perioperative chemotherapy		2.312 (1.39-3.21)	0.039
	Right colonic neoplasms	Worse OS	2.412 (1.39-2.81)	0.046
	T-stage of primary tumor (T3-T4)		1.862 (1.43-2.78)	0.048
	RAS mutation		2.222 (1.42-3.07)	0.037
	CRS > 3		2.752 (1.83-3.62)	0.032
	Absence of perioperative chemotherapy		2.162 (1.40-3.06)	0.042
Nierop et al[102]	Non-dHGP	Higher risk of positive resection margins	1.7871 (1.112-2.871)	0.016
	Number of CRLM		1.1531 (1.077-1.234)	< 0.001
	Non-dHGP	Worse OS	1.57 (1.26-1.95)	< 0.001
	Positive resection margins		1.41(1.13-1.76)	0.002
	Age at resection		1.016 (1.008-1.023)	< 0.001
	Node positive primary		1.455 (1.226-1.728)	< 0.001
	Number of CRLM		1.078 (1.039-1.118)	< 0.001
	Size of CRLM		1.063 (1.035-1.091)	< 0.001
	Preoperative CEA	No difference in OS	1.000 (1.000-1.000)	0.898

¹Odds ratio.

²Risk ratio.

Numbers are presented as median (range) or mean ± SD unless otherwise indicated. AC: Adjuvant chemotherapy; CEA: Carcinoembryonic antigen; CI: Confidence interval; CRLM: Colorectal liver metastases; CRS: Clinical risk score; DFS: Disease-free survival; HR: Hazard ratio; LR: Liver resection; MILS: Minimally invasive surgery; non-dHGP: Non-desmoplastic growth pattern; OLR: Open liver resection; OS: Overall survival; PET-CT: Positron emission tomography-computed tomography; RFS: Recurrence-free survival; SUV: Standard uptake value.