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01-12-2009 | 2009 SSAT Plenary Presentation

Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi-institutional Analysis

Authors: Mechteld C. de Jong, Skye C. Mayo, Carlo Pulitano, Serena Lanella, Dario Ribero, Jennifer Strub, Catherine Hubert, Jean-François Gigot, Richard D. Schulick, Michael A. Choti, Luca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 12/2009

Abstract

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.

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Title: Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi-institutional Analysis
Authors: Mechteld C. de Jong
Skye C. Mayo
Carlo Pulitano
Serena Lanella
Dario Ribero
Jennifer Strub
Catherine Hubert
Jean-François Gigot
Richard D. Schulick
Michael A. Choti
Luca Aldrighetti
Gilles Mentha
Lorenzo Capussotti
Timothy M. Pawlik
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-1050-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Repeat Curative Intent Liver Surgery is Safe and Effective for Recurrent Colorectal Liver Metastasis: Results from an International Multi-institutional Analysis

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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