Impact of primary colorectal cancer site on surgical outcomes for liver metastases: A retrospective study.

BACKGROUND: Colorectal cancer is a common malignancy with increasing incidence, and 15%-25% of patients develop liver metastases with poor prognosis. Recent evidence suggests that primary tumor location significantly influences embryological origin, anatomical structure, clinical manifestations, and outcomes, yet traditional clinical approaches have treated all colorectal cancer sites as a single entity. AIM: To investigate how the anatomical origin of primary colorectal tumors influences surgical outcomes in patients presenting with hepatic metastases. METHODS: This cross-sectional investigation encompassed 178 patients diagnosed with colorectal cancer hepatic metastases who received treatment at our institution between January 2014 and January 2024. Based on postoperative disease progression, participants were stratified into two groups: Those experiencing tumor recurrence (n = 88) vs those without recurrence (n = 90). Demographic and clinical characteristics were systematically compared between groups. Multivariate logistic regression analysis was subsequently applied to variables demonstrating statistical significance, enabling identification of independent predictors of postoperative recurrence in colorectal cancer patients with liver metastases. Additionally, we examined associations between primary tumor location and various prognostic factors, while evaluating recurrence patterns across different anatomical sites during the 12-month postoperative period. RESULTS: Analysis revealed that right-sided colonic origin (55.68%), presence of nodal involvement (92.05%), elevated D-dimer levels ≥ 180 μg/L, hypoalbuminemia (albumin < 29 g/L), suboptimal or absent neoadjuvant treatment (43.18%), and elevated clinical risk scores (53.41%) constituted independent predictors of postoperative recurrence in hepatic metastatic colorectal cancer. Primary tumor location demonstrated positive associations with lymphatic spread, D-dimer elevation, and clinical risk stratification, while showing inverse relationships with albumin levels and neoadjuvant therapy effectiveness. Among the entire cohort of 178 patients, those with right-sided primary tumors exhibited substantially higher recurrence frequencies at 3-month (53.57%), 6-month (55.17%), and 12-month (55.68%) intervals compared to left-sided colonic primaries (32.14%, 24.14%, 26.14%) and rectal primaries (14.29%, 20.69%, 18.18%), with statistically significant differences observed. CONCLUSION: Right-sided colonic primary location, lymphatic metastasis, D-dimer elevation, hypoalbuminemia, neoadjuvant therapy response, and clinical risk stratification emerged as significant determinants of postoperative recurrence in patients with colorectal cancer hepatic metastases.