Outcomes after repeat hepatectomy for colorectal liver metastases from the colorectal liver operative metastasis international collaborative (COLOMIC)

Abstract

Background Resection of colorectal liver metastasis (CLM) is beneficial when feasible. However, the benefit of second hepatectomy for hepatic recurrence in CLM remains unclear. Methods The Colorectal Liver Operative Metastasis International Collaborative retrospectively examined 1004 CLM cases from 2000 to 2018 from a total of 953 patients. Hepatic recurrence after initial hepatectomy was identified in 218 patients. Kaplan–Meier analysis was performed for overall survival (OS) and recurrence‐free survival (RFS). Propensity score matching (PSM) was performed to offset selection bias. Cox proportional‐hazards regression was performed to identify risk factors associated with OS. Results A total of 51 patients underwent second hepatectomy. Unadjusted median OS was 60.1 months in repeat‐hepatectomy versus 38.3 months in the single‐hepatectomy group (p = 0.015). In the PSM population, median OS remained significantly better in the repeat‐hepatectomy group (60.1 vs. 33.1 months; p = 0.0023); median RFS was 12.4 months for the repeat‐hepatectomy group, versus 9.8 months in the single‐hepatectomy group (p = 0.0050). Repeat hepatectomy was associated with lower risk of death (hazard ratio: 0.283; p = 0.000012). Obesity, tobacco use, and high intraoperative blood loss were associated with significant risk of death (p < 0.05). Conclusion In CLM with hepatic recurrence, second hepatectomy was beneficial for OS. With PSM, the OS benefit of performing a second hepatectomy remained significant.

The impact of recurrence timing and tumor burden score on overall survival among patients undergoing repeat hepatectomy for colorectal liver metastases

“…5 Despite the recent introduction of novel multidrug chemotherapeutic regimens and biological agents, repeat hepatectomy for the recurrent intrahepatic disease remains a safe treatment approach, providing a potential improvement in oncologic outcomes. [6][7][8][9] Prior studies have demonstrated a positive association between repeat hepatectomy and favorable long-term outcomes among patients experiencing a recurrence of previously resected CRLM. 10,11 For example, Sutton et al reported that patients who underwent repeat hepatectomy had a 47% reduction in the risk of death compared with individuals who received systemic chemotherapy, even after adjusting for various clinicopathological imbalances between the two groups.…”

“…The National Comprehensive Cancer Network guideline recommends several treatment options for recurrent CRLM, including re‐resection, local therapy, and systemic chemotherapy 5 . Despite the recent introduction of novel multidrug chemotherapeutic regimens and biological agents, repeat hepatectomy for the recurrent intrahepatic disease remains a safe treatment approach, providing a potential improvement in oncologic outcomes 6–9 …”

Comparison of outcomes between surgical treatment of colorectal cancer metastatic to the liver and the peritoneum: Review of the literature

“…14 NCCN guidelines do not list CRS/HIPEC as a treatment option for colorectal cancer with PSD, 15 even though a recent phase III multicenter randomized trial demonstrated a 42-month median OS for complete cytoreduction of colorectal peritoneal carcinomatosis. 16 There are multiple studies reviewing outcomes of metastasectomy for colorectal liver disease [17][18][19][20] and for peritoneal surface metastases; [21][22][23][24] however, studies comparing the two are lacking. The goal of this article will be to review the current literature comparing outcomes between surgical management of colorectal liver metastases and colorectal PSD.…”

Rehepatectomia para tratamento da recorrência de metástases hepáticas de câncer colorretal: análise comparativa dos resultados precoces e tardios

“…40,61,62 Um achado importante observado em nosso estudo foi o de que porcentagem similar de pacientes de ambos os grupos permaneceu livre de doença a longo prazo, o que também foi observado por outros autores, e denota o potencial de cura da reabordagem cirúrgica em casos selecionados. [63][64][65] Poucos autores avaliaram os resultados da reabordagem cirúrgica em pacientes com RP (≤ 6 meses) após a primeira hepatectomia. 66,67 Os estudos existentes mostram que este subgrupo de pacientes tem pior prognóstico.…”

“…Apesar disso, com citado anteriormente, nosso objetivo foi avaliar os resultados da rehepatectomia a partir de um estudo de "vida real', utilizando os critérios de seleção empregados na rotina clínica do Serviço.Acreditamos que a utilização de critérios de inclusão bem definidos, excluindo pacientes submetidos a hepatectomias em dois tempos, e ressecções não curativas sejam suficientes para as comparações pretendidas. Outro fator que pode ter impactado nossos resultados foi o pequeno número de pacientes, em especial, no subgrupo submetido à rehepatectomia por RP, o que pode ter influenciado na ausência de diferença na sobrevida quando comparada ao grupo RT, pelo aumento do erro beta.Apesar das limitações, acreditamos que tenhamos conseguido resultados consistentes e fidedignos, os quais demonstram os benefícios da rehepatectomia para pacientes selecionados com recorrências das MHCCR, sendo este um dos maiores estudos publicados sobre o tema 40,64,65.…”