Aggressive repeat liver resection for hepatic metastases of colorectal carcinoma

Abstract

Although hepatectomy for liver metastases from colorectal carcinoma is an effective treatment, recurrence in the liver is still the most common site after hepatectomy. Thirty patients underwent hepatectomy for hepatic metastases and 17 of them had recurrence in the remnant liver during the following 12-year period. Six of the 17 patients underwent a removal of isolated hepatic recurrences. Two of the six patients underwent a third hepatectomy, and three patients underwent partial lung resection on a total of five occasions. There were no operative deaths while complications after a third hepatectomy contributed to a high morbidity rate of 40 per cent. The mean length of survival of the six patients was 28.5 months from the second hepatectomy. The prognosis of the six patients who underwent a repeat hepatectomy was significantly better than that of patients with unresectable recurrence after an initial hepatectomy (p less than 0.01). The overall 5-year survival of 29 patients excluding one in-hospital death was 44.7 per cent. Our results reveal that aggressive removal of isolated and resectable recurrent disease has the potential to improve the prognosis of selected patients with metastatic cancer.

Repeat hepatectomy for liver metastases from colorectal primary cancer: A review of the literature

“…In 2004, two studies showed that the addition of targeted therapies increased the objective response rate and the progression-free period [42,43]. Nevertheless, 50% to 70% of patients eventually develop a recurrence after hepatectomy; recurrence is isolated within the liver in a third of cases [37,40,44,45]. Surveillance in anticipation of liver recurrence must be a constant concern in the management of patients with liver metastases from CRC.…”

Repeat Hepatectomy for Recurrent Colorectal Metastases

“…Several other studies found that the median survival with recurrent colorectal metastases to the liver ranged from 16 to 46 months after repeat hepatectomy. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] On the other hand, the median survival of patients with unresectable recurrence after first hepatectomy was only 5-14 months. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] A comparison of resection results with historical findings on unresectable liver metastases strongly suggests that survival could be prolonged by Fig.…”

“…In the present study, the incidence of postoperative complications after second hepatectomy (22%) was not significantly higher than that after first hepatectomy (11%). Other studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] have reported complication rates ranging from 15% to 52%. Pinson et al reported that the most common complications were hemorrhage, pleural effusion, abscess formation, pneumonia, biliary leakage, biliary stenosis, and transient hepatic failure.…”

Search for Theragnostic Biomarkers in Colorectal Liver Metastases: Focus on the Host Immune Cells

“…Even if it is reasonable that these variables affect survival, they are of limited utility in the daily clinically practice. The use of only these variable does not allow to stratify the long-term outcome especially in the current era of modern and efficient SC (15,28,29). Similar considerations may be done for the histopathologic features, such as fibrous pseudocapsule formation, the degree of fibrosis around the metastases, single-versus confluent-node growing, infiltrative versus expansive type of growth, and invasion of intrahepatic vascular structures (30)(31)(32).…”