title: Repeat hepatic resection for colorectal liver metastases.
abstract: BACKGROUND
  Some 75-80 per cent of patients undergoing liver resection for colorectal liver metastases develop intrahepatic recurrence. A significant number of these can be considered for repeat liver surgery. This study examined the outcomes of repeat liver resection for the treatment of recurrent colorectal metastases confined to the liver.
  
  
  METHODS
  Patients who underwent repeat liver resection in a single tertiary referral hepatobiliary centre were identified from a database. Clinicopathological variables were analysed to assess factors predictive of survival.
  
  
  RESULTS
  A total of 195 patients underwent repeat resection between 1993 and 2010. Median age was 63 years, and the median interval between first and repeat resection was 13·8 months. Thirty-three patients (16·9 per cent) underwent completion hemihepatectomy or extended hemihepatectomy and the remainder had non-anatomical or segmental resection. The 30-day mortality rate was 1·5 per cent, and the overall 30-day morbidity rate was 20·0 per cent. Overall 1-, 3- and 5-year survival rates were 91·2, 44·3 and 29·4 per cent respectively. Tumour size 5 cm or greater was the only independent predictor of overall survival (relative risk 1·71, 95 per cent confidence interval 1·08 to 2·70; P = 0·021). Neoadjuvant chemotherapy before resection, perioperative blood transfusion, bilobar disease, R1 resection margin and multiple metastases were among factors that did not significantly influence survival.
  
  
  CONCLUSIONS
  Repeat hepatic resection remains the only curative option for patients presenting with recurrent colorectal liver metastases.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Adair
authors.forename: A L
authors.initials: AL
authors.lastname: Young
authors.forename: A J
authors.initials: AJ
authors.lastname: Cockbain
authors.forename: D
authors.initials: D
authors.lastname: Malde
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous; D017115:Catheter Ablation / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation; D055815:Young Adult