title: Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases.
abstract: BACKGROUND
  The recurrence rate for colorectal liver metastases after repeat hepatic resection is high, and selection criteria for repeat hepatectomy are still controversial.
  
  
  METHODS
  Clinical data of patients undergoing repeat hepatectomy for metastatic colon cancer were reviewed retrospectively and compared with those of initial hepatectomy and other treatments to determine criteria for repeat hepatectomy and to confirm its efficacy.
  
  
  RESULTS
  For 22 patients who underwent repeat hepatectomy, no mortality and an 18% morbidity rate were observed. The 3-year survival rate after repeat hepatectomy was 49%. The only poor prognostic factor after repeat hepatectomy was a serum carcinoembryonic antigen level greater than 50 ng/mL before initial hepatectomy. The prognosis for patients who underwent repeat hepatectomy and had shown high carcinoembryonic antigen levels before initial hepatectomy was approximately equal to that for the patients who received systemic chemotherapy or hepatic arterial infusion for unresectable tumors in the remnant liver.
  
  
  CONCLUSIONS
  Repeat hepatectomy for colorectal liver metastases can be performed safely and appears to be as effective as initial hepatectomy. However, for patients with a carcinoembryonic antigen level greater than 50 ng/mL before the initial hepatectomy, repeat hepatic resection alone may not be as effective, and a new strategy is needed.
authors.affiliation: Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kazuto
authors.initials: K
authors.lastname: Inoue
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakagouri
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate
chemical_list: D002272:Carcinoembryonic Antigen