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Background. A retrospective multiinstitutional study was performed to assess survival benefits
of patients undergoing repeat liver resection for colorectal metastasis. An updated
report is presented here.
Methods. The series comprised 170 patients from 20 different institutions around the world.
Mean age of patients was 58 years (range, 28 to 84 years). The mean and median follow-up
were 29 and 25 months, respectively.
Results. Three- and 5-year overall survival rates were 45% and 32%, respectively. The Dukes'
stage of the primary tumor showed a 34% 5-year survival rate for those patients with
negative nodes and 30% if nodes were positive (p=0.42). The disease-free interval
between liver resections showed a better outcome for those who had undergone repeated
liver resections less than 1 year from the first liver resection (42% versus 23% 5-year
survival rates); the difference was not significant (p=0.58). The number of metastases
found and resected at second procedures did not show significant differences in survival
and was probably due to selection criteria. Anatomic resections reached a better 5-year
survival rate (39%) than wedge resections (21%). The difference was not statistically
significant (p=0.2). The presence of extrahepatic disease and residual liver tumor
left behind when repeat liver resection was performed were the most important prognostic
variables in survival. Patients with extrahepatic disease had 19% 5-year survival
rate, whereas those without disease outside the liver had 36% 5-year survival rate
(p=0.09). Patients with complete resections and those with residual liver disease
after repeat resections had 36% and 17% 5-year survival rates, respectively (p=0.01).
Presence of postoperative morbidity after second liver resections did not show a significant
negative impact in survival (p=0.70). Adjuvant therapies were not widely used after
liver resections and did not seem to improve prognosis of patients who were treated
(39% versus 29% 5-year survival rates, p=0.9).
Conclusions. Repeat liver resections for colorectal metastasis is a justified approach because
surgery remains the only potentially curative treatment. These procedures are relatively
safe with low morbidity and mortality rates. Long-term survival (32%) can only be
achieved in selected patients.
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Article info
Publication history
Accepted:
June 9,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
