Surgical strategy for colorectal cancer with synchronous liver and extrahepatic metastases - A scoring system and decision tree model

Sep 29, 2026

Background: Hepatectomy for patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD) remains unclear. This study evaluated the efficacy of liver surgery and defined selection criteria for surgical candidates. Methods: From July 2007 to October 2018, 475 patients undergoing liver resection for CRLM were retrospectively reviewed; 65 with SCRLM + SEHD were analyzed. Prognostic factors were identified and used to generate a risk score system and decision tree model. Results: 5-year survival was 21.9%; key factors included >5 SCRLM, non-lung SEHD sites, inability to achieve R0, and BRAF mutation.

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J Chin MedAssoc Original article Surgical strategy for colorectal cancer with synchronous liver and extrahepatic metastases: A scoring system and decision tree model Chan-Wei Tsenga, Hao-Wei Tengb,c, Chun-Chi Linc,d, Hao-Jan Leia,c,*, Jung-Jyh Hungc,e, Wen-Yih Liangc,f, Cheng-Yuan Hsiaa,c, Shu-Cheng Choua,c, Hung-Hsin Linc,d, Sheng-Chieh Huangc,d, Hou-Hsuan Chengc,d, Yuan-Tzu Lanc,d, Huann-Sheng Wangc,d, Shung-Haur Yangc,d, Wei-Shone Chenc,d, Jen-Kou Linc,d, Jeng-Kai Jiangc,d, Shih-Ching Changc,d, Gar-Yang Chaua,c aDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDivision of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cSchool of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDivision of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; eDivision of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: The role of hepatectomy in a specific group of patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD) is still unclear. The aim of this study was to evaluate the efficacy of liver surgery and define the selection criteria for surgical candidates in patients with SCRLM + SEHD. Methods: Between July 2007 and October 2018, 475 patients with colorectal cancer with liver metastases (CRLM) who underwent liver resection were retrospectively reviewed. Sixty-five patients with SCRLM + SEHD were identified and included in the study. Clinical pathological data of these patients were analyzed to evaluate the influence on survival. Important prognostic factors were identified by univariate and multivariate analyses. The risk score system and decision tree analysis were generated according to the important prognostic factors for better patient selection. Results: The 5-year survival rate of patients with SCRLM + SEHD was 21.9% . The most important prognostic factors were SCRLM number of more than five, site of SEHD other than the lung only, inability to achieve SCRLM + SEHD R0 resection, and BRAF mutation of cancer cells. The proposed risk score system and decision tree model easily discriminated between patients with different survival rates and identified the profile of suitable surgical patients. Conclusion: Liver surgery should not be a contraindication for patients with SCRLM + SEHD. Patients with complete SCRLM + SEHD R0 resection, SCRLM number less than or equal to five, SEHD confined to the lung only, and wild-type BRAF could have favorable survival outcomes. The proposed scoring system and decision tree model may be beneficial to patient selection in clinical use. Keywords: Colorectal cancer with liver metastases; Extrahepatic metastases; Liver resection; Scoring system; Synchronous metastases 1. INTRODUCTION Colon and rectal cancer (CRC) constitute the third most common cancer worldwide,1 and approximately 26% to 30% of CRCs develop synchronous or metachronous liver metastases during the disease course.2,3 Liver metastases are the main cause *Address correspondence. Dr. Hao-Jan Lei, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: hjlei@vghtpe.gov.tw](ROC. E-mail address: hjlei@vghtpe.gov.tw) (H.-J. Lei). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 732-739. Received January 20, 2023; accepted May 19, 2023. doi: 10. 1097/JCMA.0000000000000947. Copyright © 2023, the Chinese Medical Association. This i

FAQs

What question does the study address about hepatectomy?

The study examines whether hepatectomy is effective for patients with synchronous colorectal cancer with liver metastases (SCRLM) and synchronous extrahepatic disease (SEHD), and how to select suitable surgical candidates.

How were eligible patients and prognostic factors identified?

Patients who underwent liver resection for colorectal cancer with liver metastases were retrospectively reviewed; 65 with SCRLM + SEHD were included. Univariate and multivariate analyses identified important prognostic factors used to build a risk score system and decision tree model.

Which factors were most strongly associated with survival?

Key prognostic factors were SCRLM number greater than five, SEHD site other than lung only, inability to achieve SCRLM + SEHD R0 resection, and BRAF mutation.

Sep 29, 2026

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