Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival

Shaw, Ian; Rees, Myrddin; Welsh, Fenella; Bygrave, Sean; John, Timothy G.

doi:10.1002/bjs.5323

Cited by 134 publications

(110 citation statements)

References 24 publications

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“…These data agree with the conclusions of a recent meta-analysis of studies assessing repeat hepatectomy for recurrent CRLM [25]. While this earlier analysis found no significant difference in overall survival between the single resection and repeat resection groups when all studies were evaluated, repetition of analyses to include just high-quality studies [11,12,14,15] or just studies with greater than 500 cases demonstrated that repeat resection was significantly associated with improved overall survival following metastasectomy. In agreement with this, Saiura et al recently found the performance of repeat resection to be independently associated with prolonged overall survival following metastasectomy [26].…”

Section: Discussionsupporting

confidence: 87%

“…Studies to date, however, have yielded conflicting results regarding the influence of repeat hepatectomy for CRLM upon longterm survival [11][12][13][14][15][16][17]. A notable finding of this study was that repeat hepatectomy was significantly associated with improved overall and cancer-specific survival following metastasectomy, along with established prognostic factors including tumor number and margin status.…”

Section: Discussionmentioning

confidence: 83%

“…There were 308 (63.1%) men and 180 (36.9%) women. At index hepatectomy, the median number of tumors on preoperative imaging was two (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Tumor size ranged from 5 to 150 mm, with a median size of 35 mm.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…While several large cohort studies have demonstrated repeat hepatectomy for recurrent CRLM to be associated with a survival benefit compared to patients undergoing a single hepatectomy [11,12], other studies have yielded comparable long-term results between the two groups [13][14][15][16][17]. In addition, although improved survival after repeat hepatectomy has been shown in some studies, varying patient outcomes have been reported within individual studies.…”

Section: Introductionmentioning

confidence: 99%

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Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

et al. 2017

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Up to three-quarters of patients undergoing liver resection for colorectal liver metastases (CRLM) develop intrahepatic recurrence. Repeat hepatic resection appears to provide the optimal chance of cure for these patients. The aim of this study was to analyze short-and long-term outcomes following index and repeat hepatectomy for CRLM. Clinicopathological data were obtained from a prospectively maintained database. Perioperative variables and outcomes were compared using the Chi-squared test. Variables associated with long-term survival following index and second hepatectomy were identified by Cox regression analyses. Over the study period, 488 patients underwent hepatic resection for CRLM, with 71 patients undergoing repeat hepatectomy. There was no significant difference in rates of morbidity (P = 0.135), major morbidity (P = 0.638), or mortality (P = 0.623) when index and second hepatectomy were compared. Performance of repeat hepatectomy was independently associated with increased overall and cancer-specific survival following index hepatectomy. Short diseasefree interval between index and second hepatectomy, number of liver metastases >1, and resection of extrahepatic disease were independently associated with shortened survival following repeat resection. Repeat hepatectomy for recurrent CRLM offers short-term outcomes equivalent to those of patients undergoing index hepatectomy, while being independently associated with improved longterm patient survival. Cancer MedicineOpen Access 332

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 83%

Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

et al. 2017

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“…Such a conservative and yet radical policy is vital in case of reduced liver functionality or in the presence of multiple lesions. Moreover, both in the case of primary and secondary liver tumors, maximizing the preservation of liver tissue not directly involved by the lesion increases the possibility of subsequent resections [2,27].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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KEYWORDSIntraoperative ultrasonography; Liver resection; Hepatocellular carcinoma; Liver metastases.Abstract Introduction: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumorevessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. Methods: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. Results: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1e4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1e12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. Conclusions: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.Sommario Premessa: Nell'ambito della chirurgia epatica l'ecografia intraoperatoria svolge un ruolo ben codificato nella stadiazione e nella pianificazione della strategia operatoria. L'importanza dell'ampio utilizzo di questa metodica anche durante la resezione è stata riportata solo da alcuni autori. Questo studio ha come scopo di verificare quali siano i risultati a breve termine di un ampio utilizzo dell'ecografia durante la resezione stessa in un ospedale periferico. Metodi: Nell'arco di 24 mesi 11 pazienti consecutivi sono stati sottoposti a resezione epatica ecoguidata. I dati perioperatori sono stati raccolti in modo prospettico per valutare l'influenza di questa metodica sulla mortalità, morbidità e recidive locali. * Corresponding author. via Peschiera 40/7, 16122 Genova, Italia.E-mail address: pietrogrondona@yahoo.com (P. Grondona). Risultati: Otto pazienti erano maschi. Età mediana 74 anni. Quattro HCC, 4 metastasi, 1 colangiocarcinoma periferico, 1 emangioma, 1 pseudotumore infiammatorio. Sono state eseguite 3 resezioni a cuneo, 3 subsegmentectomie, 4 segmentectomie e 3 bisegmentectomie. La perdita ematica mediana è stata 235 ml. In caso di tumore il margine di exeresi mediano è st...

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A Second Liver Resection Due to Recurrent Colorectal Liver Metastases—Invited Critique

Pawlik¹

2007

Arch Surg

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Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival

Abstract: The beneficial outcomes observed after repeat liver resection in selected patients with RCLM confirm the experience of others and support its status as the preferred choice of treatment for such patients.

Cited by 134 publications

References 24 publications

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

Ultrasound-guided liver resection: Early experience in a district general hospital

A Second Liver Resection Due to Recurrent Colorectal Liver Metastases—Invited Critique

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