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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2015

01-08-2015 | Hepatobiliary Tumors

Recurrence After Partial Hepatectomy for Metastatic Colorectal Cancer: Potentially Curative Role of Salvage Repeat Resection

Authors: Jean M. Butte, MD, Mithat Gönen, PhD, Peter J. Allen, MD, T. Peter Kingham, MD, Constantinos T. Sofocleous, MD, PhD, Ronald P. DeMatteo, MD, Yuman Fong, MD, Nancy E. Kemeny, MD, William R. Jarnagin, MD, Michael I. D’Angelica, MD

Published in: Annals of Surgical Oncology | Issue 8/2015

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Abstract

Purpose

Patients with recurrence after complete resection of colorectal liver metastases (CLM) are considered for repeat resection as a potential salvage therapy (PST). However, outcomes for this approach are not well defined. We sought to analyze the natural history of recurrence and PST in a large cohort of patients with long-term follow-up.

Methods

Recurrence patterns, treatments, and outcomes in consecutive patients undergoing resection for colorectal liver metastases were analyzed retrospectively. PST was defined as repeat resection of all recurrent disease and effective salvage therapy (EST) as free of disease for 36 months after last PST. Factors associated with PST, EST, and outcomes were analyzed.

Results

Of 952 patients who underwent resection, 594 (62 %) experienced recurrence (median interval = 13 months). Initial recurrences involved liver (n = 157,26 %), lung (n = 167,28 %), multiple sites (n = 171,29 %), and other single sites (n = 99,17 %). PST was performed in 160 (27 %) of 594, most commonly with a single site of recurrence (n = 149). Young age (p = 0.01), negative initial resection margin (p = 0.003), initial tumor size <5 cm (p = 0.006), and recurrence pattern (p < 0.001) were independently associated with PST. Thirty-six patients experienced EST (25 % of PSTs). Overall median survival was 61 and 43 months in those with recurrence. Median survival of patients undergoing PST was 87 months compared to 34 months for those who did not.

Conclusions

Recurrence is common after CLM resection, but 27 % of patients were able to undergo PST. Approximately one-quarter of these experienced EST and may be cured. PST is associated with long-term survival and possible cure, and therefore active surveillance after CLM resection is justified.
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Metadata
Title
Recurrence After Partial Hepatectomy for Metastatic Colorectal Cancer: Potentially Curative Role of Salvage Repeat Resection
Authors
Jean M. Butte, MD
Mithat Gönen, PhD
Peter J. Allen, MD
T. Peter Kingham, MD
Constantinos T. Sofocleous, MD, PhD
Ronald P. DeMatteo, MD
Yuman Fong, MD
Nancy E. Kemeny, MD
William R. Jarnagin, MD
Michael I. D’Angelica, MD
Publication date
01-08-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 8/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4370-1

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