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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2021

Open Access 01-02-2021 | Metastasis | Hepatobiliary Tumors

Recurrence After Liver Resection of Colorectal Liver Metastases: Repeat Resection or Ablation Followed by Hepatic Arterial Infusion Pump Chemotherapy

Authors: Florian E. Buisman, MD, Wills F. Filipe, MD, Nancy E. Kemeny, MD, Raja R. Narayan, MD MPH, Rami M. Srouji, MD, Vinod P. Balachandran, MD, Thomas Boerner, MD, Jeffrey A. Drebin, MD PhD, William R. Jarnagin, MD, T. Peter Kingham, MD, Alice C. Wei, MD, Dirk J. Grünhagen, MD PhD, Cornelis Verhoef, MD PhD, Bas Groot Koerkamp, MD PhD, Michael I. D’Angelica, MD FACS

Published in: Annals of Surgical Oncology | Issue 2/2021

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Abstract

Background

The aim of this study was to investigate the effectiveness of adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after complete resection or ablation of recurrent colorectal liver metastases (CRLM).

Methods

A retrospective cohort study was conducted of patients from two centers who were treated with resection and/or ablation of recurrent CRLM only between 1992 and 2018. Overall survival (OS) and hepatic disease-free survival (hDFS) were estimated using the Kaplan–Meier method. The Cox regression method was used to calculate hazard ratios (HRs) with corresponding 95% confidence intervals (CI).

Results

Of 374 eligible patients, 81 (22%) were treated with adjuvant HAIP chemotherapy. The median follow-up for survivors was 65 months (IQR 32–118 months). Patients receiving adjuvant HAIP were more likely to have multifocal disease and receive perioperative systemic chemotherapy at time of resection for recurrence. A median hDFS of 46 months (95% CI 29–81 months) was found in patients treated with adjuvant HAIP compared with 18 months (95% CI 15–26 months) in patients treated with resection and/or ablation alone (p = 0.001). The median OS and 5-year OS were 89 months (95% CI 52–126 months) and 66%, respectively, in patients treated with adjuvant HAIP compared with 57 months (95% CI 47–67 months) and 47%, respectively, in patients treated with resection and/or ablation only (p = 0.002). Adjuvant HAIP was associated with superior hDFS (adjusted HR 0.599, 95% CI 0.38–0.93, p = 0.02) and OS (adjusted HR 0.59, 95% CI 0.38–0.92, p = 0.02) in multivariable analysis.

Conclusion

Adjuvant HAIP chemotherapy after resection and/or ablation of recurrent CRLM is associated with superior hDFS and OS.
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Literature
1.
Takamoto T, Hashimoto T, Miyata A, Shimada K, Maruyama Y, Makuuchi M. Repeat hepatectomy after major hepatectomy for colorectal liver metastases. J Gastrointest Surg. 2019;24(2):380–7.PubMedCrossRef
2.
Matsuoka H, Morise Z, Tanaka C, et al. Repeat hepatectomy with systemic chemotherapy might improve survival of recurrent liver metastasis from colorectal cancer—a retrospective observational study. World J Surg Oncol. 2019;17(1):33.PubMedPubMedCentralCrossRef
3.
Valdimarsson VT, Hellberg K, Brismar TB, Sparrelid E, Sturesson C. Repeat procedures for recurrent colorectal liver metastases: analysis of long-term liver regeneration and outcome. Cancer Manag Res. 2019;11:2617–22.PubMedPubMedCentralCrossRef
4.
Dupre A, Jones RP, Diaz-Nieto R, Fenwick SW, Poston GJ, Malik HZ. Curative-intent treatment of recurrent colorectal liver metastases: a comparison between ablation and resection. Eur J Surg Oncol. Oct 2017;43(10):1901–7.PubMedCrossRef
5.
Kulik U, Bektas H, Klempnauer J, Lehner F. Repeat liver resection for colorectal metastases. Br J Surg. 2013;100(7):926–32.PubMedCrossRef
6.
Lam VW, Pang T, Laurence JM, et al. A systematic review of repeat hepatectomy for recurrent colorectal liver metastases. J Gastrointest Surg. 2013;17(7):1312–21.PubMedCrossRef
7.
Nordlinger B, Sorbye H, Glimelius B, et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013;14(12):1208–15.PubMedCrossRef
8.
Hof J, Wertenbroek MW, Peeters PM, Widder J, Sieders E, de Jong KP. Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases. Br J Surg. 2016;103(8):1055–62.PubMedCrossRef
9.
de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250(3):440–8.PubMed
10.
Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med. 1999;341(27):2039–48.PubMedCrossRef
11.
Kemeny NE, Gonen M. Hepatic arterial infusion after liver resection. N Engl J Med. 17 2005;352(7):734–5.PubMedCrossRef
12.
Kemeny NE, Chou JF, Boucher TM, et al. Updated long-term survival for patients with metastatic colorectal cancer treated with liver resection followed by hepatic arterial infusion and systemic chemotherapy. J Surg Oncol. 2016;113(5):477–84.PubMedPubMedCentralCrossRef
13.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 318–321.PubMedPubMedCentralCrossRef
14.
Buisman FE, Galjart B, van der Stok EP, et al. Recurrence patterns after resection of colorectal liver metastasis are modified by perioperative systemic chemotherapy. World J Surg. 2019;44(3):876–86.
15.
Kemeny MM, Adak S, Gray B, et al. Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy—an intergroup study. J Clin Oncol. 2002;20(6):1499–1505.
16.
Groot Koerkamp B, Sadot E, Kemeny NE, et al. Perioperative hepatic arterial infusion pump chemotherapy is associated with longer survival after resection of colorectal liver metastases: a propensity score analysis. J Clin Oncol. 2017;35(17):1938–44.PubMedPubMedCentralCrossRef
17.
Dupre A, Rehman A, Jones RP, et al. Validation of clinical prognostic scores for patients treated with curative-intent for recurrent colorectal liver metastases. J Surg Oncol. 2018;117(6):1330–6.PubMedCrossRef
18.
Gholami S, Kemeny NE, Boucher TM, et al. Adjuvant hepatic artery infusion chemotherapy is associated with improved survival regardless of KRAS mutation status in patients with resected colorectal liver metastases: a retrospective analysis of 674 patients. Ann Surg. 2019.
19.
Okuno M, Goumard C, Kopetz S, et al. RAS mutation is associated with unsalvageable recurrence following hepatectomy for colorectal cancer liver metastases. Ann Surg Oncol. 2018;25(8):2457–66.PubMedCrossRef
20.
Margonis GA, Amini N, Buettner S, et al. The prognostic impact of primary tumor site differs according to the KRAS mutational status: a study by the international genetic consortium for colorectal liver metastasis. Ann Surg. 2019.
21.
Gagniere J, Dupre A, Gholami SS, et al. Is hepatectomy justified for BRAF mutant colorectal liver metastases? a multi-institutional analysis of 1497 patients. Ann Surg. 2018;271(1):147–154CrossRef
Metadata
Title
Recurrence After Liver Resection of Colorectal Liver Metastases: Repeat Resection or Ablation Followed by Hepatic Arterial Infusion Pump Chemotherapy
Authors
Florian E. Buisman, MD
Wills F. Filipe, MD
Nancy E. Kemeny, MD
Raja R. Narayan, MD MPH
Rami M. Srouji, MD
Vinod P. Balachandran, MD
Thomas Boerner, MD
Jeffrey A. Drebin, MD PhD
William R. Jarnagin, MD
T. Peter Kingham, MD
Alice C. Wei, MD
Dirk J. Grünhagen, MD PhD
Cornelis Verhoef, MD PhD
Bas Groot Koerkamp, MD PhD
Michael I. D’Angelica, MD FACS
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08776-0

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