Prognostic value of postoperative carcinoembryonic antigen concentration and extent of invasion of resection margins after hepatic resection for colorectal metastases

Objective: To evaluate the prognostic value of postoperative concentration of carcinoembryonic antigen (CEA) and extent of surgical margins after resection of liver metastases from colorectal cancer. Design: Retrospective study. Setting: Teaching hospital, Switzerland. Subjects: 49 patients with hepatic metastases after primary colorectal cancer. Interventions: Resection of hepatic metastases Main outcome measures: Assessment of prognostic value of variables by univariate and multivariate analysis. Results: Median survival was 24 months (range 5-86 months). Resection margins were clear (>1-cm) in 10, close (<1-cm) in 25 and invaded in 9 patients. On univariate analysis, a postoperative concentration of CEA of <4ng/ml was correlated with prolonged survival (p < 0.001), but the width of the resection margin was not of prognostic importance. There was no correlation between width of resection margins and postoperative concentration of CEA (p = 0.5). On multivariate analysis, postoperative concentrations of CEA of 4 ng/ml or more were associated with increased risk of death (relative risk 7.3; 95% confidence interval (CI) 2.8-18.7, p < 0.001). Conclusion: Postoperative CEA offers better prognostic discrimination than the width of resection margins after rt:section of liver metastases from colorectal tumours. Some patients with invaded resection margins did survive for 3 years, but no patient did whose CEA concentration was 4 ng/ml or more. The definition of a potentially curative hepatic resection should include a postoperative CEA concentration of <4 ng/ml (within the reference range).