Ann Surg Treat Res.  2019 Jul;97(1):7-14. 10.4174/astr.2019.97.1.7.

Repeat hepatectomy for recurred colorectal liver metastasis: is it justified?

• Park J
• Lee SD
• Han SS
• Kim SH
• Park SJ
• Oh JH
• Joo J

• KMID: 2450984
• DOI: http://doi.org/10.4174/astr.2019.97.1.7

Abstract

PURPOSE
Liver resection is considered the only curative treatment modality for colorectal liver metastasis. The recurrence rate after hepatectomy is >50%. Two or more hepatectomies are applied to treat recurred metastases. We assessed the efficiency and feasibility of repeat hepatectomy and analyzed the prognostic factors after a repeat hepatectomy.
METHODS
In total, 248 patients were diagnosed with recurred liver metastasis between January 2003 and May 2016. Second and third hepatectomies were performed in 70 and 7 patients, respectively. The other 171 patients did not undergo a repeat hepatectomy. Clinical features were collected from the medical records. We analyzed survival rates of the repeat hepatectomy group and the nonrepeat hepatectomy group. We also investigated factors affecting overall and disease-free survival of patients who received a repeat hepatectomy using univariate and multivariate analyses.
RESULTS
Median overall survival was significantly higher in the repeat hepatectomy group than in the nonrepeat group (83.0 months vs. 25.0 months, P < 0.001). The morbidity and mortality rates of repeat hepatectomy were 9.1% and 0%, respectively. Median overall and disease-free survival of the repeat hepatectomy group were 62.0 and 51.0 months, respectively. The number of recurred tumors was the only significant factor for disease-free survival (P = 0.029). None of the factors affected overall survival.
CONCLUSION
Repeat hepatectomy is necessary, effective, and safe for treating recurred colorectal liver metastasis. Repeat hepatectomy can be considered in patients with fewer than three recurred metastatic tumors.

Keyword

Colorectal neoplasms; Hepatectomy; Feasibility studies; Prognosis; Recurrence

MeSH Terms

Colorectal Neoplasms
Disease-Free Survival
Feasibility Studies
Hepatectomy*
Humans
Liver*
Medical Records
Mortality
Multivariate Analysis
Neoplasm Metastasis*
Prognosis
Recurrence
Survival Rate

Figure

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  Fig. 1 Flow diagram for patient selection. CRLM, colorectal liver metastasis.

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  Fig. 2 Overall survival of the repeat hepatectomy and nonrepeat hepatectomy groups.

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  Fig. 3 Overall (A) and disease-free survival (B) rates of patients who underwent a second hepatectomy.

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  Fig. 4 Overall survival after a third hepatectomy (dotted line) and without a third hepatectomy (solid line).

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