title: [Recurrent colorectal liver metastases: who benefits from a second hepatic resection?].
abstract: BACKGROUND
  Hepatic recurrence is seen in approximately 40 % of patients undergoing hepatectomy for colorectal metastases. The authors assessed the benefit and the main prognostic factors for a second liver resection of recurrent colorectal metastases.
  
  
  METHODS
  This study reports the experience with second liver resections for recurrent liver metastases at a German University Hospital. A total of 39 parameters from 60 patients were identified from a prospective database and analysed as to their influence on recurrence-free survival and overall survival.
  
  
  RESULTS
  At a median follow-up of 26 months (range: 2-173 months) after second hepatic resection, recurrence-free survival at 3 and 5 years were 50 % and 37 %, respectively. The overall survival at three and five years were 61 % and 52 %, respectively. Recurrence was identified in 58.3 % of the patients. Recurrences involved exclusively the liver in 19 patients (31.6 %). By multivariate analysis (Cox proportional hazard model), a time interval between diagnosis of the liver metastases of less than 24 months after operation for colorectal primary carcinoma (HR: 6.47, p = 0.002), a CEA level of 4.0 ng/mL or more (HR: 3.48, p = 0.004) at the time of first liver metastases and a size of second liver metastases of 80 mm or more (HR: 4.73, p = 0.007) were independent prognostic factors for a reduced recurrence-free survival. A repeat recurrence of liver metastases without the option of curative resection was the only risk factor for overall survival after second hepatic resection (p = 0.009). In these cases, mortality risk was 4.51-fold, however, when the second liver recurrence was resectable, the mortality risk increased only 1.4-fold.
  
  
  CONCLUSIONS
  Technically resectable recurrent colorectal hepatic metastases should be resected the same as the first metastases. Characteristics of the primary metastasis as well as parameters of the hepatic recurrence are shown to influence the prognosis of patients after resection of recurrent liver metastases. Repeat resection of colorectal liver metastases allows for improved survival in patients even after two previous liver operations.
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Konopke
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Volk
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Gastmeier
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Ehehalt
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Distler
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: H-D
authors.initials: HD
authors.lastname: Saeger
authors.affiliation: Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der , Technischen Universität Dresden, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Kersting
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003299:Cooperative Behavior; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006498:Hepatectomy; D006785:Hospitals, University; D006801:Humans; D033183:Interdisciplinary Communication; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D047368:Tumor Burden