Patterns of recurrence following liver resection for colorectal metastases: effect of primary rectal tumor site

Abstract

Hypothesis: Patients with rectal adenocarcinoma are at increased risk of locoregional recurrence compared with patients with colon cancer. This may affect the pattern of recurrence and survival rates following hepatic resection of liver metastases from rectal adenocarcinoma.

Design: Retrospective review of a prospectively collected cancer center database.

Patient and methods: From April 1, 1984, to December 31, 2005, 582 patients with liver metastases from a primary colorectal adenocarcinoma underwent hepatic resection. Clinical and pathological factors were analyzed using Cox regression analyses and log-rank tests.

Results: Of 582 patients, 141 (24.2%) had liver metastases from a primary rectal tumor site. Treatment of the primary rectal tumor most frequently included chemoradiation therapy (59.6%) and low anterior resection (63.1%). Most rectal tumors were pathological stage T3/T4 (85.8%) and N1 (68.1%). Treatment directed at the hepatic metastases included resection only (81.5%), resection plus radiofrequency ablation (17.8%), or radiofrequency ablation only (0.7%). With a median follow-up time of 30.7 months, 80 of 141 patients (56.7%) developed recurrence; 23 patients (16.3%) developed recurrence in the pelvis. Of 23 patients with pelvic recurrence, 56.5% also developed recurrence in the liver. The 3- and 5-year survival rates for all patients were 62.4% and 36.4%, respectively. Of 80 patients who had a recurrence following hepatic metastectomy, 23 (28.8%) underwent another operation. Following repeat metastectomy, 3- and 5-year survival rates were 76.7% and 38.6%, respectively.

Conclusions: Following resection of hepatic rectal metastases, pelvic recurrence is relatively common, and most patients with pelvic recurrence will also develop recurrence in the liver. Surgery for recurrent disease following hepatic resection of rectal metastases is warranted among well-selected patients.

Figure 1

The 5-year risk of hepatic recurrence was 49.0% compared with 23.4% for pelvic recurrence. Of note, the risk of hepatic and pelvic recurrence appeared to plateau at about 3 years.

Figure 2

A, Compared with primary colon cancer, patients with primary rectal tumors had a similar disease-free survival rate. B, There was no significant difference in overall 5-year survival rate of patients who had primary colon vs rectal tumors.

Figure 3

A, In patients with a primary rectal tumor, the number of recurrence sites was associated with survival following metastectomy. Patients who developed recurrence at only 1 disease site had a significantly better long-term survival rate compared with patients who developed recurrence at multiple anatomic sites. B, The location of the recurrent disease did not, however, affect outcome. Survival was similar among patients who developed recurrence, regardless of whether the site of recurrence was the pelvis, the liver, or another anatomic site.