title: Outcome after repeat resection of liver metastases from colorectal cancer.
abstract: BACKGROUND
  Although advances in multimodal treatment have led to prolongation of survival in patients after resection of colorectal liver metastasis (CRC-LM), most patients develop recurrence, which is often confined to the liver. Repeat hepatic resection (RHR) may prolong survival or even provide cure in selected patients. We evaluated the perioperative and long-term outcomes after RHR for CRC-LM in a single institution series.
  
  
  METHODS
  Since 1999, 92 repeat hepatic resections (63% wedge/segmental, 37% hemihepatectomy or greater) for recurrent CRC-LM were performed in 80 patients. Median interval from initial liver resection to first RHR was 1.25 years. Any kind of chemotherapy (CTx) had been given in 88% before RHR. Neoadjuvant CTx was given in 38%.
  
  
  RESULTS
  Hepatic margin-negative resection was achieved in 79%. Mortality was 3.8%. Overall complication rates were 53%, including infection (17%), operative re-intervention (12%), and hepatic failure (5.4%). Overall 5-year survival after first RHR was 50.3%. Univariately, primary tumor stage, the extent of liver resection, postoperative complications, and the overall resection margin correlated with survival. By multivariate analysis, primary T stage, size of metastasis, and overall R0 resection influenced survival. Survival was not independently influenced by hepatic resection margins or (neoadjuvant) CTx.
  
  
  CONCLUSIONS
  Repeat hepatic resection for recurrent CRC-LM can be performed with low mortality and acceptable morbidity. Survival after repeat hepatic resection in this selected group of patients is encouraging and comparable to results after first liver resections.
authors.affiliation: Department of General and Digestive Surgery, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. hannes.neeff@uniklinik-freiburg.de
authors.forename: Hannes P
authors.initials: HP
authors.lastname: Neeff
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.forename: Philipp
authors.initials: P
authors.lastname: Holzner
authors.forename: Andrea
authors.initials: A
authors.lastname: Klock
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D003710:Demography; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome