Recurrence location after resection of colorectal liver metastases influences prognosis.
OBJECTIVE
To assess the impact of first recurrence location on survival following surgery of colorectal liver metastases.


METHODS
A total of 265 consecutive patients with colorectal liver metastases undergoing liver surgery (2000-2011) were categorized according to first site of tumor recurrence. Time to recurrence (TTR) and overall survival (OS) were determined. Uni- and multivariate analysis were performed to identify factors associated with TTR and OS.


RESULTS
Median TTR was 1.16 years following liver resection, and 0.56 years following radiofrequency ablation (RFA). Intrahepatic recurrence following liver resection resulted in a significantly shorter median TTR compared to extrahepatic recurrence. Intrapulmonary recurrence was associated with superior survival compared to other recurrence locations. Such patterns were not observed in the RFA-treated group. Multivariate analysis identified the type of surgical treatment and extra-hepatic first-site recurrence (other than lung) as independent predictors for OS. Pre-operative chemotherapy and simultaneous intrahepatic and extrahepatic recurrence were independent predictors for both TTR and OS.


CONCLUSIONS
Patients with intrahepatic recurrence following liver resection have a significantly shorter TTR and OS when compared to patients developing extrahepatic recurrence. Pulmonary recurrence following resection is associated with longer survival. Simultaneous intra- and extrahepatic recurrence is an independent prognostic factor for TTR and OS.
Department of Surgery, University Medical Center Utrecht, Room G04-228, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
K M
KM
Govaert
C S
CS
van Kessel
E J A
EJ
Steller
B L
BL
Emmink
I Q
IQ
Molenaar
O
O
Kranenburg
R
R
van Hillegersberg
I H M
IH
Borel Rinkes
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
D000970:Antineoplastic Agents