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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2016

01-12-2016 | Hepatobiliary Tumors

Outcomes of Rehepatectomy for Colorectal Liver Metastases: A Contemporary Multi-Institutional Analysis from the French Surgical Association Database

Authors: Julie Hallet, Antonio Sa Cunha, Rene Adam, Diane Goéré, Daniel Azoulay, Jean-Yves Mabrut, Fabrice Muscari, Christophe Laurent, Francis Navarro, Patrick Pessaux, On behalf of French Colorectal Liver Metastases Working Group. Association Française de Chirurgie (AFC)

Published in: Annals of Surgical Oncology | Special Issue 5/2016

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Abstract

Background

Recurrence remains frequent after curative-intent hepatectomy for colorectal liver metastases (CRLM). We sought to define short- and long-term outcomes, and identify prehepatectomy factors associated with survival, following rehepatectomy (RH) for recurrence.

Methods

We conducted a multi-institutional cohort study of hepatectomy for CRLM over 2006–2013. Second-stage resections were excluded. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS) assessed using Kaplan–Meier methods. Secondary outcomes included 30-day overall morbidity and mortality, and survival from recurrence. Outcomes of RH and initial hepatectomy (IH) were compared.

Results

Of 2771 hepatectomies included in the study, 447 were RH. Median operative time, 30-day morbidity, mortality, and median length of stay did not differ for RH and IH. Five-year OS did not statistically differ, i.e. 56.5 % from RH and 67.6 % from IH [adjusted hazard ratio (HR) 0.9, 95 % confidence interval (CI) 0.5–1.7], and 5-year RFS was inferior after RH (18.5 vs. 28.8 %; adjusted HR 1.3, 95 % CI 1.0–1.7). In patients who eventually recurred, 5-year survival from the time of recurrence did not differ whether it was after RH (46.5 %) or after IH (60.3 %) (adjusted HR 1.1, 95  % CI 0.8–1.8). Rectal primary tumor (HR 1.4, 95 % CI 1.0–2.1) and metastasis ≥3 cm (HR 1.3, 95 % CI 1.1–2.7) were independently associated with RFS, but not OS, after RH.

Conclusion

Short-term outcomes of RH did not differ from IH. While recurrence was more frequent after RH than IH, it did not impact OS. Survival from the time of recurrence did not differ whether recurrence occurred after RH or after IH. CRLM recurrence can be treated with curative intent with excellent long-term outcomes.
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Metadata
Title
Outcomes of Rehepatectomy for Colorectal Liver Metastases: A Contemporary Multi-Institutional Analysis from the French Surgical Association Database
Authors
Julie Hallet
Antonio Sa Cunha
Rene Adam
Diane Goéré
Daniel Azoulay
Jean-Yves Mabrut
Fabrice Muscari
Christophe Laurent
Francis Navarro
Patrick Pessaux
On behalf of French Colorectal Liver Metastases Working Group. Association Française de Chirurgie (AFC)
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue Special Issue 5/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5506-7

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