SURVIVAL OUTCOME OF TWO OR MORE RESECTIONS OF RECURRENCE WITH OR WITHOUT EXTRAHEPATIC DISEASE AFTER FIRST CURATIVE RESECTION FOR COLORECTAL LIVER METASTASES
Bradford J. Kim*1, Elena Panettieri2, Yoshikuni Kawaguchi3, Francesco Ardito2, Caterina Mele2, Agostino Maria De Rose2, Maria Vellone2, Timothy E. Newhook1, Hop Tran Cao1, Yun Shin Chun1, Ching-Wei D. Tzeng1, Felic Giulilante2, Jean-Nicolas Vauthey1
1Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; 2Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; 3University of Tokyo, Tokyo, Japan
Background: Recurrence after curative intent hepatectomy for colorectal liver metastases (CRLM) is a common event. Only a few reports focus on the role of repeated resections for multiple sites of recurrences. The objective of this study was to determine if number and specific site of recurrence after hepatectomy for CRLM impact survival.
Methods: Between 1998-2016, patients who underwent subsequent resection following curative intent resection for CRLM were included from two high-volume academic medical centers (Houston, USA & Rome, Italy). The impact of recurrence site and number of recurrences were evaluated. Patients with incomplete resections and synchronous extrahepatic disease were excluded. Resection of colorectal metastases different from Lung or Liver were labeled as Other. Survival curves were generated using the Kaplan-Meier method, and differences between curves were evaluated with the log-rank test.
Results: Among 2163 patients that underwent curative intent liver resection, 1456 (67.3%) developed a recurrence. Four hundred and seventy-eight patients underwent resection of recurrence (One Resection: 322, 67.4%; Two or more resections: 156, 32.6%). Five -year overall survival (OS) was significantly different in patients with resected and unresected recurrence, respectively (70.2% vs. 24.0%; p<0.001), Figure 1. 5-year OS was not significantly different in patients that underwent one (67.7%), two (76.3%; p=0.319) or at least 3 (73.2%; p=0.361) resections, Figure 2. In patients that underwent resection of solely one site of recurrence, 5-year OS was different based on location (Lung: 81.6%, Liver: 64.3%, Other: 54.1%, p<0.05). In patients that underwent ?2 resections of recurrence, 5-year OS was 87.5% for patients that underwent resection of liver recurrence only, 66.1% for patients that underwent resection of liver + other sites (p=0.223), and 80.7% for patients that underwent other sites of recurrence resection (p=0.258). There was no difference in 5-year OS when the first-resection was in liver (78.5%) or lung (81.8%), p=0.502, while resection of other (61.1%) sites of metastases did worse, p=0.045.
Conclusion: Multiple resections of recurrence after curative-intent hepatectomy for CRLM improve survival regardless of number of resections. Site of resections impacts survival and should be considered.
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