Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET)

• Published in: Annals of surgery 2004-09, Vol.240 (3), p.438-450
• Main Authors: Fernandez, Felix G, Drebin, Jeffrey A, Linehan, David C, Dehdashti, Farrokh, Siegel, Barry A, Strasberg, Steven M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma - diagnostic imaging; Carcinoma - mortality; Carcinoma - secondary; Carcinoma - surgery; Colorectal Neoplasms - pathology; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Hepatectomy; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Original and Discussions; Prognosis; Radiopharmaceuticals; Risk Factors; Survival Rate; Tomography, Emission-Computed
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/01.sla.0000138076.72547.b1

To report the first 5-year overall survival results in patients with colorectal carcinoma metastatic to the liver who have undergone hepatic resection after staging with [18F] fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET). The 5-year overall survival after hepatic resection for colorectal cancer metastases without preoperative FDG-PET has been established in 19 studies (6070 patients). The median 5-year overall survival rate in these studies is 30% and has not improved over time. FDG-PET detects unsuspected tumor in 25% of patients considered to have resectable hepatic metastasis by conventional staging. From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET. A prospective database was maintained. One hundred patients (56 men, 44 women) were studied. Metastases were synchronous in 52, single in 63, unilateral in 78, and 3 segments) in 75 and resection margins were > or = 1 cm in 52. Median follow up was 31 months, with 12 actual greater than 5-year survivors. There was 1 postoperative death. The actuarial 5-year overall survival was 58% (95% confidence interval, 46-72%). Primary tumor grade was the only prognostic variable significantly correlated with overall survival. Screening by FDG-PET is associated with excellent postresection 5-year overall survival for patients undergoing resection of hepatic metastases from colorectal cancer. FDG-PET appears to define a new cohort of patients in whom tumor grade is a very important prognostic variable.