A Systematic Review of Repeat Hepatectomy for Recurrent Colorectal Liver Metastases
- 674 Downloads
Selected patients with recurrent colorectal liver metastases (CLM) may be resectable by repeat hepatectomy approach. In this review, we aim to collate and evaluate the published evidence for repeat hepatectomy in patients with recurrent CLM.
Searches of the Medline and Embase databases were undertaken to identify studies of repeat hepatectomy in patients with recurrent CLM focusing on the perioperative treatment regimen, operative strategy, morbidity, technical success and survival outcomes.
Twenty-two observational studies were reviewed. A total of 1,610 patients underwent second hepatectomy for recurrent CLM. The median percentage of extra-hepatic disease was 15 % (range, 0–39 %). Preoperative chemotherapy was reported in 5/22 studies. Major liver resection was undertaken in 25 % (range, 9–59 %) of patients and the R0 resection rate was 90 % (range, 77–96 %). Postoperative morbidity and mortality after the second hepatectomy were 23 % and 1.2 %, respectively. Recurrence rate after second hepatectomy was 63.9 % (range, 42–91 %) with a median follow-up period of 32 months (range, 19–59 months). Median overall survival was 35 months (range, 19–56 months). The 3-year and 5-year overall survival rates were 55 % (range, 11–82 %) and 42 % (range, 31–73 %), respectively.
Second hepatectomy is safe and feasible in selected patients with recurrent CLM and is associated with acceptable perioperative and survival outcomes. Future prospective studies are required to further define the patient selection criteria for repeat hepatectomy and the exact role of perioperative chemotherapy.
KeywordsColorectal liver metastases Hepatectomy Surgery Recurrence Colorectal cancer
- 3.Van Cutsem E, Rivera F, Berry S, Kretzschmar A, Michael M, Dibartolomeo M, Mazier M-A, Canon J-L, Georgoulias V, Peeters M et al.: Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 2009, 20(11):1842–1847.PubMedCrossRefGoogle Scholar
- 5.Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004, 239(6):818–825; discussion 825–817.PubMedCrossRefGoogle Scholar
- 7.Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM: Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004, 240(3):438–447.PubMedCrossRefGoogle Scholar
- 16.Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. In: Third Symposium on Systematic Reviews: Beyond the Basics. Oxford; July 2000.Google Scholar
- 17.National Health and Medical Research Council: A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra, ACT: AusInfo; 1999.Google Scholar
- 18.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009, 62(10):e1-34.PubMedCrossRefGoogle Scholar
- 22.de Jong MC, Mayo SC, Pulitano C, Lanella S, Ribero D, Strub J, Hubert C, Gigot J-F, Schulick RD, Choti MA et al.: Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg 2009, 13(12):2141–2151.PubMedCrossRefGoogle Scholar
- 46.Tomlinson JS, Jarnagin WR, Dematteo RP, Fong Y, Kornprat P, Gönen M, Kemeny N, Brennan MF, Blumgart LH, D'Angelica M: Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 2007, 25(29):4575–4580.Google Scholar
- 51.Folprecht G, Gruenberger T, Bechstein WO, Raab R, Lordick F, Hartmann JT, Lang H, Frilling A, Stoehlmacher J, Weitz J et al.: Tumour response and secondary resectability of colorectal liver metastases following neoadjavant chemotherapy with cetuximan: the CELIM randomized phase 2 trial. Lancet Oncol 2010, 11:38–47.PubMedCrossRefGoogle Scholar
- 53.Adams RB, Aloia TA, Loyer EM, Pawlik TM, Taouli B, Vauthey J-N: Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB 2012, (In Press).Google Scholar
- 54.Chua TC, Saxena A, Liauw W, Chu F, Morris DL: Hepatectomy and resection of concomitant extra-hepatic disease for colorectal liver metastases--a systematic review. Eur J Cancer 2012, 48(12):1757–1765.Google Scholar
- 57.Masi G, Loupakis F, Salvatore L, Fornaro L, Cremolini C, Cupini S, Ciarlo A, Del Monte F, Cortesi E, Amoroso D et al.: Bevacizumab with FOLFOXIRI (irinotecan, oxaliplatin, fluorouracil, and folinate) as first-line treatment for metastatic colorectal cancer: a phase 2 trial. Lancet Oncol 2010, 11(9):845–852.PubMedCrossRefGoogle Scholar
- 58.Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M et al.: Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008, 371(9617):1007–1016.PubMedCrossRefGoogle Scholar