Multivariate analysis of predictive factors for early postoperative death after colorectal surgery in patients with colorectal cancer and synchronous unresectable liver metastases

Purpose: Surgery of the primary tumor in patients with colorectal cancer and unresectable synchronous liver metastases remains controversial. This study was designed to evaluate predictive preoperative factors of early postoperative death (< 3 months) in such patients. Methods: This study included 80 patients who underwent colorectal resection (n=56) or diversion stoma (n=24) for colorectal cancer with unresectable liver metastases. Twenty-two patients (28 percent) died during the first three months after surgery with two (2.5 percent) in-hospital postoperative deaths. Analysis of predictive preoperative factors for three-month postoperative death risk was performed. Results: In univariate analysis, age older than 75 years (P=0.01), American Society of Anesthesiologists grade > II (P=0.009), symptomatic patient (P=0.01), bowel obstruction (P=0.03), aspartate aminotransferase serum level > 50 (1.5 N) IU/L (P=0.008), and alkaline phosphatase > 200 (2 N) IU/L (P=0.02) were prognostic risk factors for three-month death after surgery. In multivariate analysis, age older than 75 years (relative risk=7.9; P=0.04) and aspartate aminotransferase serum level > 50 IU/L (relative risk=8.3; P=0.03) were independent risk factors. Conclusions: In patients with colorectal cancer and synchronous unresectable liver metastases, the three-month mortality rate was high (28 percent). Thus, better knowledge of risk factors could help select patients who could possibly benefit from surgery. The study suggested that age older than 75 years and liver cytolysis (> 1.5 N) are associated with an increased three-month postoperative death risk. In these patients, surgery should be avoided.