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Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases

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Journal of Gastrointestinal Surgery

Abstract

Objective

This study assessed predictors of survival after repeat hepatectomy and the feasibility of a repeat hepatectomy after a major hepatectomy in the patients with colorectal liver metastases (CLM).

Background

More than half of all patients who receive a curative initial hepatectomy for CLM develop hepatic recurrence, and aggressive indications for a repeat hepatectomy can improve the outcome in selected patients. However, the feasibility of repeat hepatectomy after major hepatectomy remains uncertain, and optimal selection criteria for repeat hepatectomy have not yet been established.

Methods

Data were collected retrospectively on 296 CLM patients who underwent an initial curative hepatectomy between 2007 and 2017 at our institution. The postoperative outcomes of patients undergoing a repeat hepatectomy after major hepatectomy were assessed, and independent predictors of survival were investigated.

Results

After a median follow-up period of 32 months, 247 patients (83%) developed disease recurrence and 122 patients (49%) underwent repeat hepatectomy. The 5-year overall survival (OS) was significantly higher in patients who underwent a repeat hepatectomy than in those who did not receive repeat hepatectomy (51% vs. 19%, respectively; P < 0.001). In a multivariate analysis, an extrahepatic lesion at the time of the repeat hepatectomy (HR, 2.49; P = 0.001) and 5 or more liver tumors at the time of recurrence (HR, 1.88; P = 0.04) remained as independent factors negatively affecting OS after repeat hepatectomy. The type of operative procedure and the intraoperative and postoperative factors at the time of the initial hepatectomy did not have any significant influence on the OS after repeat hepatectomy. No significant difference in OS was found between patients who received repeat hepatectomy after major hepatectomy (n = 43) and those after non-major hepatectomy (n = 79).

Conclusions

The operative procedure and the liver tumor status at the time of the initial hepatectomy have little impact on the indications for a repeat hepatectomy for recurrent CLM. Repeat hepatectomy is feasible even if major hepatectomy was initially performed.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Takeshi Takamoto, Takuya Hashimoto, Akinori Miyata, Kei Shimada, Yoshikazu Maruyama & Masatoshi Makuuchi

Authors
  1. Takeshi Takamoto
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  2. Takuya Hashimoto
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  3. Akinori Miyata
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  4. Kei Shimada
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  5. Yoshikazu Maruyama
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  6. Masatoshi Makuuchi
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Contributions

Takeshi Takamoto performed data analysis and wrote the manuscript with support from Takuya Hashimoto, Akinori Miyata, Kei Shimada, Yoshikazu Maruyama, and Masatoshi Makuuchi. All authors contributed to data collection, discussed the results, and contributed to the final manuscript.

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Correspondence to Takeshi Takamoto.

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Takamoto, T., Hashimoto, T., Miyata, A. et al. Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases. J Gastrointest Surg 24, 380–387 (2020). https://doi.org/10.1007/s11605-019-04154-8

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  • DOI: https://doi.org/10.1007/s11605-019-04154-8

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