title: Determinants of repeat curative intent surgery in colorectal liver metastasis.
abstract: BACKGROUND
  Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported.
  
  
  METHODS
  An institutional database (January 2002-December 2012) was reviewed to evaluate factors influencing repeat CIS.
  
  
  RESULTS
  One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63%) recurred. Fifty-three patients (52%) underwent a repeat CIS. After repeat CIS, 33 patients (62%) developed a second recurrence, and in 13 patients (39%), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p < 0.001). Overall 5-year survival in all patients was 55%; patients who recurred had a 5-year survival of 67% if they underwent repeat CIS vs. 7.8% if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months.
  
  
  CONCLUSIONS
  Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
authors.affiliation: Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, 17033-0850, USA.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.forename: Neil H
authors.initials: NH
authors.lastname: Bhayani
authors.forename: Audrey L
authors.initials: AL
authors.lastname: Stokes
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome