Resections of liver metastases of colorectal cancer (CRC) are performed with increasing frequency, due to advances in multimodal therapy, low mortality and relatively good outcomes. However, only few data have been reported regarding the results of repeat liver resections for recurrent metastases. We, therefore, analyzed our experience of those selected patients in whom a second liver resection could be performed.
Methods: From 2002 until 2006 thirty-six patients had a second liver resection for recurrent hepatic metastases of CRC in our department (28% female, median age 64 years) a median of 16 months after first liver resection. In all patients other (extrahepatic) tumor manifestations were excluded during preoperative staging (CT/MRI, PET). Eighty-four percent of the patients had received chemotherapy prior to re-resection. A segmental or atypical resection was performed in 23 patients whereas the other 13 patients underwent hemihepatectomy. During five of the 36 re-resections an additional radiofrequency thermoablation was done. Survival analysis was performed using the Kaplan-Meier-method. The median follow-up after hepatic re-resection was two years (n=34).
Results: Two of the 36 patients died postoperatively (hospital mortality 5.6%). Perioperative complications (any) occurred in 50%, surgical complications in 25% and hepatic insufficiency in two patients (5.6%). Blood transfusions were necessary in 37% of the re-resections. Free hepatic resection margins could be achieved in 78%. During follow-up eight of 34 patients died of recurrent CRC. The cumulative two- and four-year survival rates in our series are currently 75% und 64%. The status of the resection margin showed a clear tendency to influence prognosis after hepatic re-resection: After a margin-negative resection four-year survival was 75% whereas it was only 36% in patients with positive margins (p=0.12). No further potential prognostic factors could be identified up to now, also because of the limited follow-up time.
Conclusions: Repeat liver resections for recurrent metastases of CRC can be performed with acceptable morbidity and mortality in selected patients. Hepatic re-resections with free margins achieved (surprisingly) high survival rates in our series. In the context of modern multimodal treatment (especially chemotherapy) hepatic re-resection should always be considered in the absence of other tumor manifestations in patients fit for major surgery.