Anatomical resection improves relapse-free survival in colorectal liver metastases in patients with KRAS/NRAS/BRAF mutations or right-sided colon cancer - a retrospective cohort study

Q: What question does the study address about CRLM surgery?

It examines whether patient characteristics can identify who benefits more from anatomical resection (AR) versus non-anatomical resection (NAR) for colorectal liver metastases (CRLM).

Q: How was relapse-free survival (RFS) assessed?

RFS was evaluated using a stratified log-rank test and summarized with Kaplan–Meier and Cox proportional hazards methods.

Q: In which patient groups did AR improve RFS compared with NAR?

AR improved RFS in patients with KRAS/NRAS/BRAF mutations and in those with right-sided colon cancer, and multivariable analysis suggested AR remained independently prognostic in these cohorts.

Sep 24, 2026

Uploaded by supergirl

The liver resection approach for colorectal liver metastases (CRLM)—anatomical resection (AR) versus non-anatomical resection (NAR)—remains debated, with concerns that important prognostic factors may be overlooked. This retrospective cohort study analyzed 729 patients treated between June 2012 and May 2019, comparing relapse-free survival (RFS) across subgroups. AR showed favorable and independent RFS benefits in patients with KRAS/NRAS/BRAF mutations or right-sided disease, while gene wild-type and left-sided cohorts did not demonstrate a significant difference.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Background

Objective

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Introduction

’Retrospective Cohort Study Anatomical resection improves relapse-free survival in colorectal liver metastases in patients with KRAS/NRAS/BRAF mutations or right-sided colon cancer: a retrospective cohort study Wenju Chang, MD, PhDa,b,e,f,d , Yijiao Chen, MMa,b , Shizhao Zhou, MMa,b , Li Ren, MD, PhDa,b,e,f, Yuqiu Xu, MBa,b , Dexiang Zhu, MD, PhDa,b,e , Wentao Tang, MD, PhDa,b , Qinghai Ye, MD, PhDc , Xiaoying Wang, MD, PhDc , Jia Fan, MD, PhDc , Ye Wei, MD, PhDa,b,e,d,* , Jianmin Xu, MD, PhDa,b,e,d,* Background: The type of liver resection (anatomical resection, AR or non-anatomical resection, NAR) for colorectal liver metastases (CRLM) is subject to debate. The debate may persist because some prognostic factors, associated with aggressive tumor biological behavior, have been overlooked. Objective: Our study aimed to investigate the characteristics of patients who would beneﬁt more from anatomical resection for CRLM. Methods: Seven hundred twenty-nine patients who underwent hepatic resection of CRLM were retrospectively collected from June 2012 to May 2019 . Treatment effects between AR and NAR were compared in full subgroup analyses. Tumor relapse-free survival (RFS) was evaluated by a stratiﬁed log-rank test and summarized with the use of Kaplan–Meier and Cox proportional hazards methods. Results: Among 729 patients, 235 (32 .2%) underwent AR and 494 (67 .8%) underwent NAR. We showed favorable trends in RFS for AR compared with NAR in the patients with KRAS/NRAS/BRAF mutation (interaction P < 0.001) or right-sidedness (interaction P < 0.05) . Patients who underwent AR had a markedly improved RFS compared with NAR in the cohorts of RAS/NRAS/BRAF mutation (median RFS 23 .2 vs. 11. 1 months, P < 0.001) or right-sidedness (median RFS 31 .6 vs. 11.5 months, P < 0.001); upon the multivariable analyses, AR [gene mutation: hazard ratio (HR) = 0.506, 95% CI = 0.371–0.690, P < 0.001; right-sidedness: HR = 0.426, 95% CI = 0.261–0.695, P = 0.001) remained prognostic independently. In contrast, patients who underwent AR had a similar RFS compared with those who underwent NAR, in the cohorts of patients with gene wild-type tumors (median RFS 20 .5 vs. 21.6 months, P = 0.333) . or left-sidedness (median RFS 15 .8 vs. 19.5 months, P = 0.294) . Conclusions: CRLM patients with gene mutation or right-sidedness can beneﬁt more from AR rather than from NAR. Keywords: anatomical resection, colorectal liver metastases, KRAS/NRAS/BRAF, relapse-free survival, right-sided colorectal cancer Introduction Worldwide, colorectal cancer (CRC) is the third most commonly diagnosed malignancy, with 1.8 million new CRC cases diagnosed annually[1] . Approximately 50% of CRC patients would develop liver metastasis, resulting in a signiﬁcant mortality rate[2] . Hepatic resection of colorectal liver metastases (CRLM) offers the best chance for cure and long-term survival[2] . Nevertheless, the postoperative relapse rate is still higher than 50% within the ﬁrst two post-hepatectomy years[3] . Precision surgical strategies could reduce relapse rates and improve survival outcomes[4] . aColorectal Cancer Center, bDepartment of General Surgery, cDepartment of Liver Surgery, dCancer Center, Zhongshan Hospital, Fudan University, eShanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai and fDepartment of General Surgery, Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen, People ’s Republic of China W.C., Y.C., S.Z., L.R., and Y.X. contributed equally to this article. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, People’s Republic of China. Tel/fax: + [86 0 216 564 2662. E-mail: xujmin@aliyun.com](86 0 216 564 2662. E-mail: xujmin@aliyun.com) (J. Xu), and E-mail: [13818

FAQs

What question does the study address about CRLM surgery?

It examines whether patient characteristics can identify who benefits more from anatomical resection (AR) versus non-anatomical resection (NAR) for colorectal liver metastases (CRLM).

How was relapse-free survival (RFS) assessed?

RFS was evaluated using a stratified log-rank test and summarized with Kaplan–Meier and Cox proportional hazards methods.

In which patient groups did AR improve RFS compared with NAR?

AR improved RFS in patients with KRAS/NRAS/BRAF mutations and in those with right-sided colon cancer, and multivariable analysis suggested AR remained independently prognostic in these cohorts.

Sep 24, 2026

Uploaded by supergirl