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Recurrence Location After Resection of Colorectal Liver Metastases Influences Prognosis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Aim

To assess the impact of first recurrence location on survival following surgery of colorectal liver metastases.

Methods

A total of 265 consecutive patients with colorectal liver metastases undergoing liver surgery (2000–2011) were categorized according to first site of tumor recurrence. Time to recurrence (TTR) and overall survival (OS) were determined. Uni- and multivariate analysis were performed to identify factors associated with TTR and OS.

Results

Median TTR was 1.16 years following liver resection, and 0.56 years following radiofrequency ablation (RFA). Intrahepatic recurrence following liver resection resulted in a significantly shorter median TTR compared to extrahepatic recurrence. Intrapulmonary recurrence was associated with superior survival compared to other recurrence locations. Such patterns were not observed in the RFA-treated group. Multivariate analysis identified the type of surgical treatment and extra-hepatic first-site recurrence (other than lung) as independent predictors for OS. Pre-operative chemotherapy and simultaneous intrahepatic and extrahepatic recurrence were independent predictors for both TTR and OS.

Conclusions

Patients with intrahepatic recurrence following liver resection have a significantly shorter TTR and OS when compared to patients developing extrahepatic recurrence. Pulmonary recurrence following resection is associated with longer survival. Simultaneous intra- and extrahepatic recurrence is an independent prognostic factor for TTR and OS.

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Acknowledgements

This study was supported by the Dutch Cancer Society (grant no. UU 2010-4608 to K.M.G., UU 2009 4367 to B.L.E. and UU 2009-4379 to E.J.A.S.) and the PON foundation (E.J.A.S.).

Conflict of Interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Room G04-228, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    K. M. Govaert, C. S. van Kessel, E. J. A. Steller, B. L. Emmink, I. Q. Molenaar, O. Kranenburg, R. van Hillegersberg & I. H. M. Borel Rinkes

Authors
  1. K. M. Govaert
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  2. C. S. van Kessel
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  3. E. J. A. Steller
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  4. B. L. Emmink
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  5. I. Q. Molenaar
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  6. O. Kranenburg
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  7. R. van Hillegersberg
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  8. I. H. M. Borel Rinkes
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Corresponding author

Correspondence to I. H. M. Borel Rinkes.

Additional information

K.M. Govaert and C.S. van Kessel contributed equally to this study.

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Fig2

Supplemental Figure 1 Kaplan Meijer curve of time to recurrence(TTR) (A) and overall survival(OS) (B) for the different recurrence categories following surgical treatment of colorectal liver metastases. (JPEG 35 kb)

(JPEG 34 kb)

High Resolution Image (TIFF 1082 kb)

High Resolution Image (TIFF 1082 kb)

11605_2014_2461_MOESM3_ESM.docx

Supplemental Table 1 Overall survival corrected for time to recurrence according to the different recurrence locations following surgical treatment of colorectal liver metastases. Values are given in medians with 95%CI. (RFA: radiofrequency ablation) (DOCX 11 kb)

11605_2014_2461_MOESM4_ESM.docx

Supplemental Table 2 Baseline characteristics of patients select for with or without neo adjuvant chemotherapy. Data is based on 262 patients (instead of 265) because data about neo adjuvant chemotherapy was lacking in 3 cases. When percentages are based on less than 263 patients, it is indicated. (RFA: radiofrequency ablation. EHD: extra hepatic disease; CRLM: colorectal liver metastases.) (DOCX 15 kb)

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Govaert, K.M., van Kessel, C.S., Steller, E.J.A. et al. Recurrence Location After Resection of Colorectal Liver Metastases Influences Prognosis. J Gastrointest Surg 18, 952–960 (2014). https://doi.org/10.1007/s11605-014-2461-0

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  • DOI: https://doi.org/10.1007/s11605-014-2461-0

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