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International Journal of Colorectal Disease

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Open Access 01-07-2013 | Original Article

Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival

Authors: K. Homayounfar, A. Bleckmann, L. C. Conradi, T. Sprenger, T. Lorf, M. Niessner, C. O. Sahlmann, J. Meller, T. Liersch, B. M. Ghadimi

Published in: International Journal of Colorectal Disease | Issue 7/2013

Abstract

Purpose

Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60 % of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a consecutive series of patients with SMR.

Methods

From 01/2001 to 11/2011, 104 out of 178 consecutive patients with R0-resection of CRC-LM developed SMR and were evaluated. The impact of surgical and Ctx re-interventions on recurrence free (RFS) and cancer-specific survival (CSS) was analyzed. Median follow-up was 28.0 (95 %CI: 19.4–37.4) months.

Results

SMR occurred in 81 patients at a single site (49× liver, 18× lung, 14× other) and in 23 patients at multiple sites. Forty-two patients were scheduled for primary surgery. Fifty-three patients were classified as non-resectable and treated with median 5.0 [IQR, 3.0–10.0] cycles of Ctx, combined with an EGFR/VEGF-antibody in 27 patients. Nine patients received best supportive care only. R0/R1 resection could be achieved in 35 patients primarily and even in 8 patients secondarily after Ctx. Surgical morbidity and mortality were 16 and 0 %, respectively. The 5-year RFS rates for patients with R0 versus R1-resection were 22 and 24 % (p = 0.948). The 5-year CSS rate for R0/R1-resected patients was 38 % versus 10 % for those patients treated by Ctx alone (p < 0.001).

Conclusion

In SMR, surgical re-intervention is feasible and safe in a remarkable number of patients and offers significantly longer CSS compared to patients without resection.

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Title: Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival
Authors: K. Homayounfar
A. Bleckmann
L. C. Conradi
T. Sprenger
T. Lorf
M. Niessner
C. O. Sahlmann
J. Meller
T. Liersch
B. M. Ghadimi
Publication date: 01-07-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 7/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1648-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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