title: Repeat hepatectomy is independently associated with favorable long-term outcome in patients with colorectal liver metastases.
abstract: Up to three-quarters of patients undergoing liver resection for colorectal liver metastases (CRLM) develop intrahepatic recurrence. Repeat hepatic resection appears to provide the optimal chance of cure for these patients. The aim of this study was to analyze short- and long-term outcomes following index and repeat hepatectomy for CRLM. Clinicopathological data were obtained from a prospectively maintained database. Perioperative variables and outcomes were compared using the Chi-squared test. Variables associated with long-term survival following index and second hepatectomy were identified by Cox regression analyses. Over the study period, 488 patients underwent hepatic resection for CRLM, with 71 patients undergoing repeat hepatectomy. There was no significant difference in rates of morbidity (P = 0.135), major morbidity (P = 0.638), or mortality (P = 0.623) when index and second hepatectomy were compared. Performance of repeat hepatectomy was independently associated with increased overall and cancer-specific survival following index hepatectomy. Short disease-free interval between index and second hepatectomy, number of liver metastases >1, and resection of extrahepatic disease were independently associated with shortened survival following repeat resection. Repeat hepatectomy for recurrent CRLM offers short-term outcomes equivalent to those of patients undergoing index hepatectomy, while being independently associated with improved long-term patient survival.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Neal
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Gael R
authors.initials: GR
authors.lastname: Nana
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Michael
authors.identifier: 0000-0002-7193-2695
authors.initials: M
authors.lastname: Jones
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Vaux
authors.initials: V
authors.lastname: Cairns
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Wee
authors.initials: W
authors.lastname: Ngu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Isherwood
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colorectal cancer; metastasectomy; prognosis