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Introduction:
Recurrent colorectal liver metastases (CRC-LM) are a common phenomenon. This has become more and more evident with the advent of multimodal therapies in combination with increased hepatic resection rates of CRC-LM.
Since complete surgical resection remains the only chance for cure, even in advanced colorectal cancer, outcomes after repeat hepatectomies for CRC-LM have to be evaluated in order to introduce this concept into standard clinical care.
Patients and Methods:
Since 1999 100 repeat hepatic resections (62% wedge/segmental, 38% hemihepatectomy or greater) have been performed for recurrent CRC-LM in 88 patients. Repeat hepatic resection was carried out after a median interval of 1.25 years. Resection criteria were not different from first liver resections. Chemotherapy including biological agents was given in 89% before repeat hepatectomy.
This was done in neoadjuvant intent in 38%. 50% of cases with neoadjuvant treatment were receiving biological agents.
Results: Margin negative hepatic resection was achieved in 80%. Overall margin negative resection was 70%. Mortality was 3.0%. Complications rates were 52% overall, including infection (17%), need for operative re intervention (12%) and hepatic failure (i.e. bilirubin > 6.0mg/dl) (5%). Overall five-year survival rate after first repeat hepatic resection (n=85) was 50.3%. In univariate analysis, primary tumor stage (p<0.04), major hepatic surgery (p=0.05), postoperative complications (p=0.05) and overall margin negative resection including extrahepatic sites (p=0.05) were predictors of survival. Multivariately, primary T stage (p<0.05) and tumor size (p<0.03) were independent predictors of survival.
Conclusion:
Despite high rates of recurrence, results after repeat hepatic resection remain encouraging in terms of 5-year survival rates. Even under challenging surgical conditions, repeat hepatectomies can be performed safely with a high rate of local margin negative resections. Specific risk factors for patients with recurrent CRC-LM undergoing repeat hepatectomies could not be found as they resemble general risk factors for metastatic colorectal disease. Repeat heaptic resections for recurrent CRC-LM should increasingly be offered to patients who meet standard hepatic resection criteria.