Local treatment for recurrent colorectal hepatic metastases after partial hepatectomy.
OBJECTIVE
The objective of the study was to identify patients who may benefit from local treatment in recurrent colorectal liver metastases.


METHODS
A total of 51 consecutive patients were treated for hepatic recurrence(s) after an initial partial hepatic resection. Surgery was considered as the primary treatment option for eligible patients. Patients with a small liver remnant after major hepatectomy were treated with radiofrequency ablation (RFA) or stereotactic body radiation therapy (SRx). SRx was given as an outpatient, emerging local treatment option for patients with intra-hepatic recurrences not eligible for surgery or RFA. Partial liver resection was performed in 36 patients (70%), RFA in ten patients (20%), and SRx in five patients (10%).


RESULTS
Median hospital stay was 7 (range, 3-62) days with a morbidity of 16% without in-hospital death. None of the patients received adjuvant chemotherapy. There was no difference in recurrence or survival between the three treatment modalities. Overall 5-year survival was 35% with an estimated median survival of 37 months. Patients with a disease-free interval between first hepatectomy and hepatic recurrence less than 6 months did not survive 3 years.


CONCLUSIONS
Resection, RFA, and SRx can be performed safely in patients with recurrent colorectal liver metastases and offer a survival that seems comparable to primary liver resections of colorectal liver metastases.
van der Pool
Anne E M
AE
Department of Surgical Oncology, Erasmus University MC-Daniel den Hoed Cancer Center, PO Box 5201, 3008, Rotterdam, AE, The Netherlands.
Lalmahomed
Z S
ZS
de Wilt
Johannes H W
JH
Eggermont
Alexander M M
AM
Ijzermans
Jan M N
JM
Verhoef
Cornelis
C
D000368:Aged; D017115:Catheter Ablation; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016634:Radiosurgery; D019233:Retreatment; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome