Repeat Hepatic Resection for Recurrent Colorectal Liver Metastases: Impact of Neoadjuvant Therapy and Long Term Outcome
Frank Makowiec*, Hannes P. Neeff, Oliver Drognitz, Andrea Klock, Ulrich T. Hopt
Dept. of Surgery, University of Freiburg, Freiburg, Germany
Although advances in surgical and multimodal treatment have lead to prolongation of survival in patients with colorectal liver metastases (CRC-LM) many patients develop recurrence that is often isolated to the liver. Repeat resection may, again, prolong survival or even heal some patients. We evaluated the perioperative (under special consideration of neoadjuvant chemotherapy; neoCTx) and long-term outcomes after repeat hepatic resection for CRC-LM in a relatively large single institution series.Methods: Since 1999 70 repeat hepatectomies (64% wedge/segmental, 36% hemihepatectomy) for recurrent CRC-LM were performed in 61 patients (8 pts. 2, one 3 re-resections). Median interval from first to first repeat liver resection was 15 months. Before repeat hepatectomy any kind of CTx had been given in 63 cases (90%). NeoCTx (CTx within 6 months before surgery) was given in 26 cases (37%), in most cases with Oxaliplatin (additional antibodies in n=11).Results: After neoCTx the number and size of metastases was slightly smaller (but n.s.). Free hepatic margins were achieved in 77% (independent of neoCTx). Mortality was 2/70 (2.9%) No mortality was observed after neoCTx. Complication rates were 52% (any), 6% (hepatic failure/bilirubine > 6 mg/dl), 17% (infectious) or 13% (relaparotomy), all independent of neoCTx. Overall five year survival (5ySurv; n=59) was 54%. The only significant prognostic factor was the number of metastases (5ySurv 71% with one vs. 46% with >one metastasis; p=0.05). Patients with >one metastasis had more positive margins (33% vs. 17% in 1 metastasis). The size of metastasis, time interval after first liver surgery, nodal status of the primary CRC, preoperative CTx, gender and (surprisingly) the resection margin did not significantly predict survival. Conclusions: Repeat hepatectomy for recurrent CRC-LM can be performed with low morbidity and acceptable morbidity. Modern NeoCTx regimen do not increase complication rates. Long term survival after repeat hepatectomy in this selected group is rather high and comparable to data after first liver resection. Patients with only one CRC-LM are best candidates for surgery. The resection margin had only a minor influence, maybe due to multimodal or repeat therapy.
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