title: A systematic review of repeat hepatectomy for recurrent colorectal liver metastases.
abstract: BACKGROUND
  Selected patients with recurrent colorectal liver metastases (CLM) may be resectable by repeat hepatectomy approach. In this review, we aim to collate and evaluate the published evidence for repeat hepatectomy in patients with recurrent CLM.
  
  
  METHODS
  Searches of the Medline and Embase databases were undertaken to identify studies of repeat hepatectomy in patients with recurrent CLM focusing on the perioperative treatment regimen, operative strategy, morbidity, technical success and survival outcomes.
  
  
  RESULTS
  Twenty-two observational studies were reviewed. A total of 1,610 patients underwent second hepatectomy for recurrent CLM. The median percentage of extra-hepatic disease was 15 % (range, 0-39 %). Preoperative chemotherapy was reported in 5/22 studies. Major liver resection was undertaken in 25 % (range, 9-59 %) of patients and the R0 resection rate was 90 % (range, 77-96 %). Postoperative morbidity and mortality after the second hepatectomy were 23 % and 1.2 %, respectively. Recurrence rate after second hepatectomy was 63.9 % (range, 42-91 %) with a median follow-up period of 32 months (range, 19-59 months). Median overall survival was 35 months (range, 19-56 months). The 3-year and 5-year overall survival rates were 55 % (range, 11-82 %) and 42 % (range, 31-73 %), respectively.
  
  
  CONCLUSIONS
  Second hepatectomy is safe and feasible in selected patients with recurrent CLM and is associated with acceptable perioperative and survival outcomes. Future prospective studies are required to further define the patient selection criteria for repeat hepatectomy and the exact role of perioperative chemotherapy.
authors.affiliation: Department of Surgery, Westmead Hospital, University of Sydney, Westmead, Sydney, NSW, 2145, Australia. vincent.lam@sydney.edu.au
authors.forename: Vincent W T
authors.initials: VW
authors.lastname: Lam
authors.forename: Tony
authors.initials: T
authors.lastname: Pang
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Laurence
authors.forename: Emma
authors.initials: E
authors.lastname: Johnston
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hollands
authors.forename: Henry C C
authors.initials: HC
authors.lastname: Pleass
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Richardson
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012086:Reoperation