Dr Pascal Gervaz

Chirurgien FMH, chirurgie interne & chirurgie viscérale

 

 

Prognostic Value of Postoperative Carcinoembryonic Antigen Concentration and Extent of Invasion of Resection Margins After Hepatic Resection for Colorectal Metastases

 

 

 

by Gervaz P, Blanchard A, Pampallona S, Mach JP, Fontolliet C, Gillet M.

 

 

Abstract

Objective

To evaluate the prognostic value of postoperative concentration of carcinoembryonic antigen (CEA) and extent of surgical margins after resection of liver metastases from colorectal cancer. DESIGN: Retrospective study.

 

Setting

Teaching hospital, Switzerland.

 

Subjects

49 patients with hepatic metastases after primary colorectal cancer.

 

Interventions

Resection of hepatic metastases

 

Main Outcome Measures

Assessment of prognostic value of variables by univariate and multivariate analysis.

 

Results

Median survival was 24 months (range 5-86 months). Resection margins were clear (> 1-cm) in 10, close (< 1-cm) in 25 and invaded in 9 patients. On univariate analysis, a postoperative concentration of CEA of <4ng/ml was correlated with prolonged survival (p < 0.001), but the width of the resection margin was not of prognostic importance. There was no correlation between width of resection margins and postoperative concentration of CEA (p = 0.5). On multivariate analysis, postoperative concentrations of CEA of 4 ng/ml or more were associated with increased risk of death (relative risk 7.3; 95% confidence interval (CI) 2.8-18.7, p < 0.001).

 

Conclusion

Postoperative CEA offers better prognostic discrimination than the width of resection margins after resection of liver metastases from colorectal tumours. Some patients with invaded resection margins did survive for 3 years, but no patient did whose CEA concentration was 4 ng/ml or more. The definition of a potentially curative hepatic resection should include a postoperative CEA concentration of <4 ng/ml (within the reference range).


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in European Journal of Surgery 2000 Jul; 166(7): 557-61.