Choice of Surveillance After Hepatectomy for Colorectal Metastases

Abstract

Study Selection: Studies containing any of the following data fields were included: recurrence after hepatectomy, rates of repeat hepatectomy, 5-year survival (overall or disease free) after hepatectomy (initial or repeat), posthepatectomy surveillance protocol, and detection of recurrence by surveillance modality. Data Extraction: Data were taken directly from a small number of articles and pooled across studies for analysis. We highlighted difficulties in assessing data quality and validity as a caveat to the interpretation of the results. Results: The rate of recurrence after hepatectomy was 58%, and the rate of hepatic recurrence was 30%. Repeat hepatectomy was performed in 9.6% of cases. Fiveyear survivals after initial and repeat hepatectomy were 29% and 38%, respectively. Many studies did not report their surveillance protocols. For those that did, computed tomography or ultrasonography with carcinoembryonic antigen measurement most commonly formed the basis of surveillance. No data related surveillance techniques to the outcomes of recurrence detection, repeat hepatectomy, or survival. Conclusions: This review confirmed the value of repeat hepatectomy for recurrent disease, but uncovered no direct evidence supporting any surveillance modalities. Further studies are clearly needed, and approaches to these are discussed.

Results of a national survey among Dutch surgeons treating patients with colorectal carcinoma. Current opinion about follow‐up, treatment of metastasis, and reasons to revise follow‐up practice

“…Among the Dutch surgeons 8-12% did not consider these patients eligible for surgery. Re-resection of metastases of both lung and liver result in near equal survival rates as after the first metastasectomy [32,34,[39][40][41][42][43][44][45]. The differences in opinion regarding eligibility for hepatic metastasectomy indicate ongoing advances in liver surgery, which allow more patients to be a candidate for curative surgery.…”

Surgical Management of Colorectal Liver Metastases

“…Most centers continue to follow-up patients for 5 years using their own protocol. A review 63 examined outcomes related to mode of surveillance post hepatectomy. It could not uncover direct evidence supporting any particular surveillance modality.…”

Resection of Colorectal Liver Metastases: Current Perspectives

“…Postoperative surveillance evaluates the efficacy of treatment as well as screening for recurrence. 124,125 According to the 2006 National Comprehensive Cancer Network guidelines, follow-up includes a physical examination, a CEA measurement, and a CT scan of the chest and abdomen every 3 months for 2 to 3 years, then every 6 months for 5 years. Some clinicians limit the use of CT scan until a measurable CEA level is noted (Fig 2).…”