TY - JOUR
T1 - Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis
T2 - Results from an international multi-institutional analysis
AU - de Jong, Mechteld C.
AU - Mayo, Skye C.
AU - Pulitano, Carlo
AU - Lanella, Serena
AU - Ribero, Dario
AU - Strub, Jennifer
AU - Hubert, Catherine
AU - Gigot, Jean François
AU - Schulick, Richard D.
AU - Choti, Michael A.
AU - Aldrighetti, Luca
AU - Mentha, Gilles
AU - Capussotti, Lorenzo
AU - Pawlik, Timothy M.
N1 - Funding Information:
Support: Dr. Pawlik is supported by grant number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
PY - 2009/12
Y1 - 2009/12
N2 - Introduction: Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0%). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25. 5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.
AB - Introduction: Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0%). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25. 5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.
KW - Colorectal cancer
KW - Liver
KW - Metastasis
KW - Repeat
KW - Resection
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U2 - 10.1007/s11605-009-1050-0
DO - 10.1007/s11605-009-1050-0
M3 - Article
C2 - 19795176
AN - SCOPUS:71149086933
SN - 1091-255X
VL - 13
SP - 2141
EP - 2151
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 12
ER -