Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases (original) (raw)
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Role of Repeated Hepatectomy in the Multimodal Treatment of Hepatic Colorectal Metastases
Archives of Surgery, 2007
Hypothesis: Multimodal treatment consisting of repeated hepatectomy and adjuvant systemic chemotherapy for liver-confined recurrence of colorectal cancer can yield long-term survival comparable with that associated with primary hepatectomy. Design: Retrospective analysis. Setting: A prospective database at a tertiary referral cancer center. Patients: Review of 274 consecutive liver resections identified 64 patients who underwent resection of hepatic colorectal metastases without ablation followed by adjuvant irinotecan hydrochloride-or oxaliplatin-based systemic chemotherapy. Main Outcome Measures: Median and 5-year overall and disease-free survival after primary and repeated hepatectomy. Results: At median follow-up of 40 months, median and 5-year overall survival after hepatectomy were 60 months and 53%, respectively; median and 5-year disease-free survival were 33 months and 25%, respectively. Multivariate analysis showed that less than 1 year between colectomy and liver resection (P=.001), more than 3 metastases (P=.001), no repeated hepatectomy (P=.01), and lymph node-positive primary colon cancer (P=.02) were independently predictive of worse survival. Of 28 patients (44%) with liver-confined recurrence, 19 (30%) underwent repeated hepatectomy; at median follow-up of 38 months, median and 5-year overall survival after repeated hepatectomy were 48 months and 44%, respectively. No risk factors were identified in multivariate analysis. In patients with recurrence, median and 5-year overall survival measured from primary hepatectomy were 70 months and 73%, respectively, with repeated hepatectomy vs 43 months and 43%, respectively, without repeated hepatectomy (P =.03). Conclusion: Multimodal treatment of recurrent colorectal cancer confined to the liver should begin with consideration of repeated hepatectomy.
Cancer medicine, 2017
Up to three-quarters of patients undergoing liver resection for colorectal liver metastases (CRLM) develop intrahepatic recurrence. Repeat hepatic resection appears to provide the optimal chance of cure for these patients. The aim of this study was to analyze short- and long-term outcomes following index and repeat hepatectomy for CRLM. Clinicopathological data were obtained from a prospectively maintained database. Perioperative variables and outcomes were compared using the Chi-squared test. Variables associated with long-term survival following index and second hepatectomy were identified by Cox regression analyses. Over the study period, 488 patients underwent hepatic resection for CRLM, with 71 patients undergoing repeat hepatectomy. There was no significant difference in rates of morbidity (P = 0.135), major morbidity (P = 0.638), or mortality (P = 0.623) when index and second hepatectomy were compared. Performance of repeat hepatectomy was independently associated with increa...
Management of intrahepatic recurrence after curative treatment of colorectal liver metastases
British Journal of Surgery, 2006
Background Management of intrahepatic recurrence after complete surgical treatment for colorectal liver metastases is not well defined. The aim of this study was to analyse the survival results of patients who had repeat liver resection for intrahepatic recurrence and to evaluate prognostic indicators for survival. Methods Between 1991 and 2005, 55 patients had repeat liver resection for isolated intrahepatic recurrence. The long-term survival results were assessed. Univariable and multivariable analyses were used to identify prognostic indicators for survival after repeat hepatectomy. Results The median survival was 53 (range 2–97) months and the 5-year survival rate was 49 per cent. In univariable analysis, size of largest initial liver metastasis, margin of initial liver surgery, carcinoembryonic antigen (CEA) level before and after initial liver surgery, liver disease-free survival, margin of repeat liver surgery, operation type of repeat surgery and CEA level before and after r...
Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases
World Journal of Surgery, 2001
Hepatectomy for liver metastases from colorectal cancer has recently received general acceptance as a safe, potentially curative treatment. Most patients, however, die of recurrent disease after hepatectomy. The predictive factors for recurrence after first resection of liver metastases have not yet been clarified. The authors aimed to determine the factors that can predict recurrence, especially hepatic-only recurrence after hepatectomy for colorectal liver metastases. Seventy-six patients who underwent liver resection of colorectal metastases were studied retrospectively. Forty-seven (61.8%) of the patients had a recurrence. The patients' disease-free survival after first hepatectomy and the second recurrence sites were univariately and multivariately analyzed using 16 clinicopathologic variables. Wall invasion, lymph node metastases, lymphatic invasion, venous invasion of the primary tumor, 24 months or longer disease-free interval after resection of the primary colorectal cancer, and bilateral liver metastases significantly influenced the disease-free survival (log-rank test: p< 0.05). The multivariate analysis revealed that venous invasion of the primary tumor and bilateral hepatic metastases were independent risk factors for recurrence after hepatectomy. The liver was the only site of second recurrence in 23 patients. Patients with lymph node metastases and venous invasion of the primary tumor had a significant difference between hepatic-only and extrahepatic recurrence after first hepatectomy (chi-square test or Fishers' exact test: p < 0.05). Recurrence after hepatectomy was influenced more by factors associated with the primary colorectal cancer than factors surrounding the first liver metastases. Venous invasion of the primary colorectal cancer was the most important predictable factor for hepatic-only second recurrence. Hepatectomy for liver metastases from colorectal cancer has received general acceptance as a safe, potentially curative treatment [1-3]. Many patients, however, die of recurrent disease after hepatectomy. The recurrence is frequently in the remnant liver. Recently, some authors reported that the patients with isolated liver recurrence after hepatectomy have a chance of long-term survival or cure after repeat hepatectomy [4-6]. Therefore it is important to determine the predictive factors for recurrence after colorectal liver metastases. In this study we investigated the pattern of a second recurrence and analyzed the factors of the primary tumor and first liver metastases associated with the second recurrence, especially hepatic-only recurrence.
Factors affecting surgical margin recurrence after hepatectomy for colorectal liver metastases
Gland surgery, 2016
Hepatic recurrence after resection of colorectal liver metastasis (CLM) occurs in 50% of patients during follow-up, with 2.8% to 13.9% presenting with surgical margin recurrence (SMR). The aim of this study is to analyze factors that related to SMR in patients with CLM undergoing hepatectomy. Demographics, clinical and survival data of patients who underwent hepatectomy were identified from a prospectively maintained, institutional review board (IRB)-approved database between 2000 and 2012. Statistical analysis was performed using univariate Kaplan Meier and Cox proportional hazard model. There were 85 female and 121 male patients who underwent liver resection for CLM. An R0 resection was performed in 157 (76%) patients and R1 resection in 49. SMR was detected in 32 patients (15.5%) followed up for a median of 29 months (range, 3-121 months). A half of these patients had undergone R1 (n=16) and another half R0 resection (n=16). Tumor size, preoperative carcinoembryonic antigen (CEA)...
Journal of Gastrointestinal Surgery, 2012
When hepatectomy is used as a primary treatment for liver metastasis from colorectal cancer (CRCLM), the balance between surgical curability and functional preservation of the remnant liver is of great importance. A total of 108 patients who underwent initial hepatectomy for CRCLM were retrospectively analyzed with respect to tumor extent, operative method, and prognosis, including recurrence. The 1-, 2-, 3-, and 5-year overall survival rates (OS) for all patients were 90.5%, 77.8%, 63.2%, and 51.6%, respectively. Multivariate analysis indicated serum carbohydrate antigen 19-9 (CA 19-9) level after hepatectomy (&amp;amp;amp;amp;amp;lt;36 or ≥36 mAU/mL) and presence of recurrence as independent prognostic factors of OS (P = 0.0458 and 0.0249, respectively), and tumor depth of colorectal cancer (&amp;amp;amp;amp;amp;lt;se (a2) vs. ≥se (a2)) and serum CA 19-9 level after hepatectomy as the significant factors affecting disease-free survival (DFS) (P = 0.0025 and 0.00138, respectively). Neither resection margin nor type of hepatectomy (anatomic or nonanatomic) for CRCLM was a significant prognostic factor for OS or DFS or CRCLM recurrence, including intrahepatic recurrence. In CRCLM, we believe that nonanatomic hepatectomy with narrow margin is indicated, and optimal treatment would include functional preservation of as much of the remnant liver as possible.
Cirugía y Cirujanos (English Edition), 2019
Introduction: A high percentage of patients undergoing hepatectomy for metastatic colorectal liver disease will have a recurrence. Of these, some can be subject to a new resection. The usefulness of repeated hepatectomy remains controversial. The aim of this study is to evaluate the results of short and long-term outcomes in repeated hepatectomies. Methods: They were re-analyzed 68 repeated hepatectomies from two institutions. Demographics, characteristics of metastatic disease and hepatic resections were analyzed. Types of complications, morbidity and mortality were also analyzed as survival and disease-free time. Some of the factors of poor prognosis mentioned in the literature were evaluated. Results: The analysis of short-term data showed no statistically significant differences between patients with first and repeated hepatectomy, except the percentage of postoperative biliary leakage (p = 0.001). The 1-year survival was similar while 3 and 5 years survival showed significant differences (p = 0.024 and 0.004, respectively). The factors of poor prognosis referred in the literature were not representative in this series. Conclusion: The short-term results of repeated hepatectomy are similar to those resected once. Long term result are inferior to other published series.
Japanese Journal of Clinical Oncology, 2006
Early recurrence is a major problem after hepatic resection of colorectal hepatic metastasis (CHM). Our aim was to investigate the relationship between time to recurrence after CHM resection and overall survival. A retrospective analysis was performed for 101 consecutive patients who underwent hepatic resection for CHM and have been followed more than 5 years. Among 101 patients, 82 (81%) had a recurrence. Overall survival of patients with recurrence within 6 months after CHM resection was significantly worse than that of patients with recurrence after more than 6 months (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Overall survival was poorer when time to recurrence was shorter. One of the reasons for poor prognosis of patients with recurrence within 6 months was that only a few patients could undergo a second resection for recurrence after CHM resection. Histological type, including poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor, bilobar metastases, microscopic positive surgical margin and carcinoembryonic antigen (CEA) above 15 ng/ml had predictive value for decreased recurrence-free survival after CHM resection. Short time to recurrence after CHM resection correlates with a poor prognosis. Histological type of poorly differentiated signet ring cell or mucinous adenocarcinoma in the primary tumor might be a predictor for early recurrence after CHM resection.