by Gervaz P, Pak-art R, Nivatvongs S, Wolff BG, Larson D, Ringel S.
Colorectal carcinoma in cirrhotic patients is different from that in patients without the liver disease. The aims of this study were to evaluate the incidence of liver metastasis, postoperative mortality, and the predictors of longterm survival.
A retrospective analysis of patients operated on for colorectal adenocarcinoma at the Mayo Clinic, Rochester, MN between 1976 and 2001, with confirmed liver cirrhosis at the time of abdominal exploration.
Seventy-two patients were available for analysis. They were 43% Child A, 42% Child B, and 15% Child C. The median age was 70 (range 42 to 89) years, and the mean duration of followup was 46 months. Postoperative death was 13%. The risk factors were an elevated bilirubin (p = 0.01) and prolonged prothrombin time (p = 0.009). Seven patients (10%) developed liver metastases. For the whole group 1-, 3-, and 5-year survival rates were 69%, 49%, and 35%, respectively. Child A patients had a significantly better survival rate than the combined group of Child B and C patients (p = 0.008). The risks for longterm survival were decreased albumin (p = 0.002) and prolonged prothrombin time (p < 0.001). TNM stage of the carcinoma provided no prognostic information (p = 0.51).
Liver metastases from colorectal adenocarcinoma is infrequent (10%) in cirrhotic patients. The Child's classification, and not the TNM stage of the carcinoma, predicts the risk of postoperative death and longterm survival.
in Journal of the American College of Surgeons 2003 Jun; 196(6): 874-9