title: Outcomes after repeat hepatic resection for recurrent metastatic colorectal cancer: A population-based study.
abstract: BACKGROUND
  More than half of the patients undergoing resection for colorectal cancer liver metastases develop recurrent hepatic disease. We report management and outcomes of patients undergoing repeat hepatectomy in routine practice.
  
  
  METHODS
  All cases of repeat hepatectomy for colorectal cancer liver metastases from 2002 to 2009 in the Canadian Province of Ontario were identified using the population-based Ontario Cancer Registry and linked treatment records.
  
  
  RESULTS
  Of 1,310 patients who underwent resection of CRLM, 78 (6.0%) underwent a repeat liver resection. Mean age was 56 years and the median time between resections was 19 months. Compared with the first resection, second resections were associated with fewer lesions (2.7 vs 1.5; P = .001) and fewer major resections (58% vs 31%; P = .024). The size of largest lesion, positive margin rate, length of hospital stay, and 90-day mortality were similar. Unadjusted 5-year overall survival from the time of second resection was 45% (95% confidence interval = 32% to 59%) and cancer-specific survival was 47% (95% confidence interval = 30% to 64%).
  
  
  CONCLUSIONS
  Repeat liver resections for metastatic CRC involve fewer lesions and less extensive surgery and a substantial proportion of patients achieve long-term survival.
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada. Electronic address: nanjis@kgh.kari.net.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Nanji
authors.affiliation: Department of Surgery, Grand River Hospital, Kitchener, Ontario, Canada.
authors.forename: Melanie E
authors.initials: ME
authors.lastname: Tsang
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Xuejiao
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clinical outcomes; Colorectal cancer; Liver metastases; Population-based study