Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis

Abstract

Objective: To determine the value of repeat liver resection for recurrent colorectal metastases to the liver.

Summary background data: Liver resection represents the best and a potentially curative treatment for metastatic colorectal cancer to the liver. After resection, however, most patients develop recurrent disease, often isolated to the liver.

Methods: This study reports the combined experience of repeat liver resection for recurrent liver metastases at an American and a European surgical oncology center. Patients were identified from prospective databases and records were retrospectively reviewed. A total of 126 patients (American n = 96, 1986-2001; European n = 30, 1985-1999) underwent repeat liver resection. Patient characteristics were similar in the two institutions. Median follow-up from first liver resection was 88 and 105 months, respectively.

Results: Operations performed included 90 minor resections and 36 resections of a lobe or more. The 1-, 3-, and 5-year survival rates were 86%, 51%, and 34%. There were 19 actual 5-year survivors to date. By multivariate regression analysis (proportional hazard model), more than one lesion and tumor size larger than 5 cm were independent prognostic indicators of reduced survival. The interval between the first and second liver resection was not predictive of outcome.

Conclusions: Repeat liver resection for colorectal liver metastases is safe. Patients with a low tumor load are the best candidates for a repeat resection. In well-selected patients, further resection of the liver can provide prolonged survival after recurrence of colorectal liver metastases.

Figure 1. Kaplan-Meier plots: Cumulative survival after second liver resection for: (A) the entire study population, (B) number of hepatic lesions = 1 (plot 1) and more than 1 (plot 2), (Continues)

Figure 1. Continued. (C) size of the largest lesion less than 5 cm (plot 1) and more than 5 cm (plot 2), and (D) the subpopulations (number = 1, size < 5: plot 1), (number = 1, size > 5: plot 2), (number > 1, size < 5, plot 3), (number > 1, size > 5, plot 4).