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Five-Year Survival After Resection of Hepatic Metastases From Colorectal Cancer in Patients Screened by Positron Emission Tomography With F-18 Fluorodeoxyglucose (FDG-PET)

Fernandez, Felix G. MD; Drebin, Jeffrey A. MD, PhD; Linehan, David C. MD; Dehdashti, Farrokh MD; Siegel, Barry A. MD; Strasberg, Steven M. MD

doi: 10.1097/01.sla.0000138076.72547.b1
Original Articles and Discussions of the American Surgical Association

Objective: 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).

Summary Background Data: 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.

Methods: From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET. A prospective database was maintained.

Results: One hundred patients (56 men, 44 women) were studied. Metastases were synchronous in 52, single in 63, unilateral in 78, and <5 cm in diameter in 60. Resections were major (>3 segments) in 75 and resection margins were ≥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.

Conclusions: 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.

The 5-year survival of 100 patients treated by hepatic resection for colorectal cancer metastatic to the liver who were staged by FDG-PET was 58%. The median overall survival in 19 previous case series not staged by FDG-PET is 30%.

From the Section of Hepatobiliary-Pancreatic Surgery, Department of Surgery, the Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.

Reprints: Steven M. Strasberg, MD, Box 8109, Suite 17308 West Pavilion Tower, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.