title: Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients.
abstract: OBJECTIVE
  The aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management.
  
  
  METHODS
  Patients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection.
  
  
  RESULTS
  A total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3-4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028).
  
  
  CONCLUSIONS
  Early recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated.
authors.affiliation: Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy, lvigano@ymail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Viganò
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Réal
authors.initials: R
authors.lastname: Lapointe
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate