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Outcome after repeat resection of liver metastases from colorectal cancer

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Abstract

Introduction

Although advances in multimodal treatment have led to prolongation of survival in patients after resection of colorectal liver metastasis (CRC-LM), most patients develop recurrence, which is often confined to the liver. Repeat hepatic resection (RHR) may prolong survival or even provide cure in selected patients. We evaluated the perioperative and long-term outcomes after RHR for CRC-LM in a single institution series.

Patients and methods

Since 1999, 92 repeat hepatic resections (63 % wedge/segmental, 37 % hemihepatectomy or greater) for recurrent CRC-LM were performed in 80 patients. Median interval from initial liver resection to first RHR was 1.25 years. Any kind of chemotherapy (CTx) had been given in 88 % before RHR. Neoadjuvant CTx was given in 38 %.

Results

Hepatic margin-negative resection was achieved in 79 %. Mortality was 3.8 %. Overall complication rates were 53 %, including infection (17 %), operative re-intervention (12 %), and hepatic failure (5.4 %). Overall 5-year survival after first RHR was 50.3 %. Univariately, primary tumor stage, the extent of liver resection, postoperative complications, and the overall resection margin correlated with survival. By multivariate analysis, primary T stage, size of metastasis, and overall R0 resection influenced survival. Survival was not independently influenced by hepatic resection margins or (neoadjuvant) CTx.

Conclusions

Repeat hepatic resection for recurrent CRC-LM can be performed with low mortality and acceptable morbidity. Survival after repeat hepatic resection in this selected group of patients is encouraging and comparable to results after first liver resections.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany

    Hannes P. Neeff, Oliver Drognitz, Philipp Holzner, Andrea Klock, Ulrich T. Hopt & Frank Makowiec

  2. Institute of Pathology, University of Freiburg, Breisacher Strasse 115a, 79106, Freiburg, Germany

    Peter Bronsert

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  1. Hannes P. Neeff
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  2. Oliver Drognitz
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Correspondence to Hannes P. Neeff.

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Neeff, H.P., Drognitz, O., Holzner, P. et al. Outcome after repeat resection of liver metastases from colorectal cancer. Int J Colorectal Dis 28, 1135–1141 (2013). https://doi.org/10.1007/s00384-013-1670-4

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