Background
The perioperative risk and long-term survival benefit of repeat hepatectomy for patients
with liver metastases from colorectal cancer, compared with that of a first liver
resection, has been reported with varying results in the literature.
Methods
The literature was searched using Medline, Embase, Ovid, and Cochrane databases for
all studies published from 1992 to 2006. Two authors independently extracted data
using the following outcomes: postoperative complications and mortality; disease recurrence;
and long-term survival. Trials were assessed using the modified Newcastle-Ottawa Score.
Random-effect meta-analytical techniques were used for analysis.
Results
Twenty-one studies met the inclusion criteria, comprising 3,741 patients. The use
of adjuvant chemotherapy was similar in both groups (odds ratio [OR] = 0.97; 95% confidence
interval [CI] = 0.54, 1.74; P = .92), as was the number of hepatic nodules present
at the time of first or second resection (weighted mean difference [WMD] = 0.18; 95%
CI = −0.22, 0.57; P = .380). Wedge resection was carried out less often at first hepatectomy
(39% vs 46%; OR = 0.66; 95% CI = 0.44, 1.00; P = .05). There was significantly less
blood loss in patients undergoing first versus second hepatectomy (WMD = 238 ml; 95%
CI = 90, 385; P = .002). There was no difference in perioperative morbidity (OR =
1.01; 95% CI = 0.65, 1.55; P = .98), mortality (OR = 1.01; 95% CI = 0.18, 5.72; P
= .99) or long-term survival (HR = 0.90; 95% CI = .66, 1.24; P = .530) between groups.
Conclusions
Repeat hepatectomy for patients with colorectal cancer metastases is safe and provides
survival benefit equal to that of a first liver resection.
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References
- Resection of colorectal liver metastases.World J Surg. 1995; 19: 59-71
- Factors influencing the natural history of colorectal liver metastases.Lancet. 1994; 343: 1405-1410
- Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history.Br J Surg. 1990; 77: 1241-1246
- Surgical decision making for large bowel cancer metastatic to the liver.Radiology. 1990; 174: 621-626
- Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.Ann Surg. 1999; 230: 309-318
- Late results justify resection for multiple hepatic metastases from colorectal cancer.Br J Surg. 1997; 84: 1136-1140
- Hepatic resection after down-staging of unresectable hepatic colorectal metastases.Surg Oncol Clin N Am. 2003; 12: 211-220
- Repeated liver resection for recurrent liver cancer.Br J Surg. 1996; 83: 893-901
- Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis.Ann Surg. 2002; 235: 863-871
- Repeat hepatic resection for recurrent colorectal liver metastases is associated with favorable long-term survival.Br J Surg. 2006; 93: 457-464
- Current perspectives on repeat hepatic resection for colorectal carcinoma: a review.Surgery. 1996; 119: 361-371
- Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumor recurrence after hepatectomy.Br J Surg. 2002; 89: 752-756
- Radiofrequency ablation of liver tumors: a systematic review.Arch Surg. 2006; 141: 181-190
- Bringing it all together: Lancet-Cochrane collaborate on systematic reviews.Lancet. 2001; 357: 1728
- Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA. 2000; 283: 2008-2012
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- The estimation and significance of the logarithm of a ratio of frequencies.Ann Hum Genet. 1956; 20: 309-311
- Statistical aspects of the analysis of data from retrospective studies of disease.J Natl Cancer Inst. 1959; 22: 719-748
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Sifting the evidence-what’s wrong with significance tests?.BMJ. 2001; 322: 226-231
- Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.Stat Med. 1998; 17: 2815-2834
- Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients.Ann Thorac Surg. 2004; 77: 745-753
- Misleading meta-analysis.BMJ. 1995; 311: 753-754
- Repeat hepatectomy for colorectal liver metastases.Ann Surg. 1997; 225: 51-60
- Repeated hepatic resection for recurrent metastases from colorectal cancer.Br J Surg. 1992; 79: 146-148
- Re-resection for colorectal liver metastasis.Surg Oncol Clin N Am. 1996; 5: 353-364
- Survival after repeat hepatic resection for recurrent colorectal metastases.Hepatogastroenterology. 1999; 46: 1065-1070
- Repeat hepatic resection for recurrent colorectal cancer.World J Surg. 1997; 21: 292-296
- Repeat hepatic resections for metastatic colorectal cancer.Ann Surg. 1994; 220: 657-662
- Complete remission of disease for 5 years following initial and repeat resection of the liver for the removal of 22 metastases of colorectal origin.J Hepatobiliary Pancreat Surg. 2003; 10: 321-324
- Repeat hepatectomy for recurrent colorectal metastases.World J Surg. 1998; 22: 1087-1091
- Repeat hepatectomy for colorectal liver metastases: a worthwhile operation?.J Surg Oncol. 2001; 76: 127-132
- Multiple repeat resections of intra- and extrahepatic recurrences in patients undergoing initial hepatectomy for colorectal carcinoma metastases.World J Surg. 2002; 26: 141-147
- Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases.J Clin Oncol. 1994; 12: 1491-1496
- Repeat hepatectomy for recurrent colorectal liver metastases.J Surg Oncol. 2006; 93: 1-7
- Repeat hepatic surgery for colorectal cancer metastasis to the liver.Ann Surg. 1996; 223: 765-773
- Repeat hepatectomy for colorectal metastases.J Hepatobiliary Pancreat Surg. 1999; 6: 30-38
- Repeat hepatectomy for recurrent colorectal metastases.Surg Today. 2005; 35: 282-289
- Impact of repeat hepatectomy on recurrent colorectal liver metastases.Surgery. 2001; 129: 421-428
- Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases.Surgery. 2003; 133: 627-634
- Procedures of choice for resection of primary and recurrent liver metastases from colorectal cancer.World J Surg. 2004; 28: 482-487
- Repeated liver resection for recurrent metastases from colorectal cancer.Hepatogastroenterology. 2003; 50: 472-474
- Repeat hepatectomy for recurrent hepatic metastases from colorectal cancer.Hepatogastroenterology. 2001; 48: 828-830
- Repeat liver resection for recurrent colorectal liver metastases.Am J Surg. 1999; 178: 275-281
- First and repeat resection of colorectal liver metastases in elderly patients.Ann Surg. 2004; 240: 858-865
- Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases.J Gastrointest Surg. 2000; 4: 178-184
- Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.Ann Surg. 2005; 241: 715-722
- Repeat hepatectomy for cancer.Br J Surg. 1993; 80: 1557-1562
- One hundred and fifty hepatic resections: evolution of technique towards bloodless surgery.Br J Surg. 1996; 83: 1526-1529
- Hepatic resection using intermittent vascular inflow occlusion and low central venous pressure anesthesia improves morbidity and mortality.J Gastrointest Surg. 2000; 4: 162-167
- Central venous pressure and its effect on blood loss during liver resection.Br J Surg. 1998; 85: 1058-1060
- Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal.Ann Surg Oncol. 2001; 8: 347-353
- Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy.Ann Surg. 1996; 224: 509-520
- Guidelines for resection of colorectal cancer liver metastases.Gut. 2006; 55: iii1-iii8
- Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer.Br J Surg. 2002; 89: 1164-1168
- Extrahepatic disease does not contraindicate hepatectomy for colorectal liver metastases.Br J Surg. 2003; 90: 567-574
- Staged pulmonary and hepatic metastasectomy in colorectal cancer—is it worth it?.Eur J Cardiothorac Surg. 2004; 25: 151-154
- Colorectal hepatic metastases: role of radiofrequency ablation.Ann Acad Med Singapore. 2003; 32: 212-218
- Adverse events during radiofrequency treatment of 582 hepatic tumors.Am J Roentgenol. 2003; 181: 695-700
- Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.Ann Surg. 2004; 239 (discussion 25-7): 818-825
- Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.Radiology. 2001; 221: 159-166
Article info
Publication history
Published online: November 23, 2006
Accepted:
July 29,
2006
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
