Repeat liver resection for recurrent colorectal metastases: a single‐centre, 13‐year experience

Battula, Narendra; Tsapralis, Dimitrios; Mayer, David; Isaac, J.; Muiesan, Paolo; Sutcliffe, Robert P.; Bramhall, Simon R.; Mirza, Darius F.; Marudanayagam, R.

doi:10.1111/hpb.12096

Cited by 54 publications

(52 citation statements)

References 43 publications

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“…25,26 However, a protocol for surveillance after CLM resection that covers both synchronous and metachronous CLM has not yet been established. Given that patients able to undergo repeat liver resection [6][7][8][9][10] or lung resection 11,12 at the time of recurrence after CLM resection have favorable survival rates compared with patients undergoing palliative nonoperative therapy, a surveillance protocol matched with the risk of recurrence after CLM resection may be helpful for detecting early manifestation of recurrence and may facilitate repeat intervention. Our surveillance algorithm requires more frequent testing and clinic visits for patients within the 0 to 2 years after CLM resection compared with other algorithms; however, given that the risk of recurrence at 2 years after CLM resection is approximately 3 times the risk of recurrence at 2 years after resection of primary colorectal tumors, we believe these recommendations are reasonable, especially because there are surgical and nonoperative treatment options for patients with recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Repeat surgery is effective for recurrence after CLM resection. Reported 5-year overall survival (OS) rates in patients who undergo resection of liver recurrence after initial CLM resection range from 41% to 73%, [6][7][8][9][10] and reported 5-year OS rates in patients who undergo resection of lung recurrence after CLM resection range from 39% to 54%. 11,12 No study has evaluated the surveillance algorithm for patients undergoing resection of both synchronous and metachronous CLM.…”

Section: Introductionmentioning

confidence: 99%

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A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

Kawaguchi

Kopetz²,

Lillemoe

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: The optimal surveillance strategy after resection of colorectal liver metastases (CLM) is unknown. We evaluated changes in recurrence risk after CLM resection and developed a surveillance algorithm. Methods: Patients undergoing CLM resection during 1998 to 2015 were identified from a prospectively compiled database and analyzed if they had the potential for follow-up longer than the longest observed time to recurrence in this cohort. Changes in recurrence risk and risk factors for recurrence were evaluated. All statistical tests were 2-sided. Results: Among 2,105 patients who were initially identified and underwent CLM resection, the latest recurrence was observed at 87 months; 1,221 consecutive patients from 1998 through 2011 with the potential for at least 87 months of follow-up were included. The risk of recurrence was highest at 0 to 2 years after CLM resection, lower at 2 to 4 years after CLM resection, and steadily lower after 4 years after CLM resection. Factors associated with increased recurrence risk at the time of surgery were primary lymph node metastasis (hazard ratio [HR], 1.54; 95% CI, 1.21–1.97; P<.001), multiple CLM (HR, 1.31; 95% CI, 1.06–1.63; P=.015), largest liver metastasis diameter >5 cm (HR, 1.64; 95% CI, 1.23–2.19; P<.001), and RAS mutation (HR, 1.29; 95% CI, 1.04–1.59; P=.020). In patients without recurrence at 2 years, the only factor still associated with increased recurrence risk was RAS mutation. In those patients, the recurrence rate at 4 years was 59.3% in patients with RAS mutation versus 27.8% in patients with RAS wild-type (P=.019). Conclusions: For patients who have undergone CLM resection, we propose surveillance every 3 to 4 months during years 0 to 2, every 3 to 4 months (if mutant RAS) versus every 4 to 6 months (if RAS wild-type) during years 2 to 4, and every 6 to 12 months if recurrence-free at 4 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

Kawaguchi

Kopetz²,

Lillemoe

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Several studies have reported complications following repeat hepatectomy, such as bile leak, perihepatic abscess, hepatic failure, postoperative bleeding, peritonitis, refractory ascites, pleural effusion, and an adhesive small bowel obstruction [22526]. Most of these complications were grade III or higher on the Clavien-Dindo classification grade.…”

Section: Discussionmentioning

confidence: 99%

Repeat hepatectomy for recurred colorectal liver metastasis: is it justified?

et al. 2019

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Purpose Liver resection is considered the only curative treatment modality for colorectal liver metastasis. The recurrence rate after hepatectomy is >50%. Two or more hepatectomies are applied to treat recurred metastases. We assessed the efficiency and feasibility of repeat hepatectomy and analyzed the prognostic factors after a repeat hepatectomy. Methods In total, 248 patients were diagnosed with recurred liver metastasis between January 2003 and May 2016. Second and third hepatectomies were performed in 70 and 7 patients, respectively. The other 171 patients did not undergo a repeat hepatectomy. Clinical features were collected from the medical records. We analyzed survival rates of the repeat hepatectomy group and the nonrepeat hepatectomy group. We also investigated factors affecting overall and disease-free survival of patients who received a repeat hepatectomy using univariate and multivariate analyses. Results Median overall survival was significantly higher in the repeat hepatectomy group than in the nonrepeat group (83.0 months vs. 25.0 months, P < 0.001). The morbidity and mortality rates of repeat hepatectomy were 9.1% and 0%, respectively. Median overall and disease-free survival of the repeat hepatectomy group were 62.0 and 51.0 months, respectively. The number of recurred tumors was the only significant factor for disease-free survival (P = 0.029). None of the factors affected overall survival. Conclusion Repeat hepatectomy is necessary, effective, and safe for treating recurred colorectal liver metastasis. Repeat hepatectomy can be considered in patients with fewer than three recurred metastatic tumors.

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“…[2,3] As for the intrahepatic recurrent tumor, various therapeutic modalities including repeat liver resection, liver transplantation, radiofrequency ablation, and transarterial chemoembolization could be used to manage it, but repeat liver resection is still performed as the first-line treatment. [4–6]…”

Section: Introductionmentioning

confidence: 99%

Outcomes of laparoscopic repeat liver resection for recurrent liver cancer

et al. 2019

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Background:With the improvements of surgical instruments and surgeons’ experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer.Methods:A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data.Results:A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: −33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = −187.33 mL; 95%CI: −249.62 to −125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06–1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23–0.76; P = .004), and shorter hospital stays (WMD = −2.31; 95%CI: −3.55 to −1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99–114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups.Conclusions:LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.

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Repeat liver resection for recurrent colorectal metastases: a single‐centre, 13‐year experience

Abstract: Repeat resection of CLM is safe and can achieve longterm survival in carefully selected patients. A preoperative knowledge of poor prognostic factors helps to facilitate better patient selection.

Cited by 54 publications

References 43 publications

A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

A New Surveillance Algorithm After Resection of Colorectal Liver Metastases Based on Changes in Recurrence Risk and RAS Mutation Status

Repeat hepatectomy for recurred colorectal liver metastasis: is it justified?

Outcomes of laparoscopic repeat liver resection for recurrent liver cancer

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