title: Outcome following repeat liver resection for colorectal liver metastases.
abstract: OBJECTIVE
  Our aim was to determine independent predictors of survival after second liver resection and to confirm whether the type of first resection influences survival after repeat resection.
  
  
  METHODS
  Fifty-four patients who underwent a second liver resection for colorectal liver metastases were analyzed. To find independent predictors of survival, possible prognostic factors regarding the primary tumor, and the first and second resections were used in the Cox regression analysis.
  
  
  RESULTS
  There were three postoperative deaths within 90 days of surgery. The 3- and 5-year overall survival rates were 53% and 46%, respectively. The size of the tumor (>50mm) (p=0.005), serum carcinoembryonic antigen level (>30microg/L) (p=0.002), and the presence of a positive surgical margin at the second resection (p=0.006) were independent predictors of poor survival following the second resection. The type of first resection was not associated with survival but was associated with the ability to achieve a histological negative surgical margin at the second liver resection (p=0.01).
  
  
  CONCLUSIONS
  Three independent predictors of survival were identified. Major initial liver resection was associated with a reduced ability to achieve surgical clearance at the second resection. For colorectal liver metastases, major resection should only be performed if a negative margin cannot be achieved by minor resection.
authors.affiliation: HPB and Transplant Unit, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: H
authors.initials: H
authors.lastname: Nishio
authors.forename: Z Z R
authors.initials: ZZ
authors.lastname: Hamady
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: S
authors.initials: S
authors.lastname: Fenwick
authors.forename: K
authors.initials: K
authors.lastname: Rajendra Prasad
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D018365:Neoplasm, Residual / Q000473:pathology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen