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The predictors and oncological outcomes of repeat surgery for recurrence after hepatectomy for colorectal liver metastases

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Abstract

Purpose

Although recurrence after hepatectomy for colorectal liver metastases (CRLM) is common, the optimal treatment strategy remains unclear. The aims of this study were to clarify the impact of repeat surgery and identify the predictive factors for repeat surgery.

Methods

Among the 170 patients who underwent potentially curative surgery for CRLM, 113 developed recurrence. The predictive factors for the performance of repeat surgery were identified and a predictive model was constructed.

Results

The patterns of recurrence were as follows; single site [n = 100 (liver, n = 61; lung, n = 22; other, n = 17)], multiple site (n = 13). Repeat surgery was performed in 54 patients (47.8%) including re-hepatectomy (n = 25), radiofrequency ablation (n = 12), and resection of the extrahepatic recurrent disease (n = 17), and their overall survival (OS) was significantly better than that of those who could not (5-year OS 60.7 vs 19.5%, P < 0.0001). A multivariate analysis revealed that a primary N-negative status [relative risk (RR) 2.93, P = 0.017], indocyanine retention rate at 15 min ≤ 10% before hepatectomy (RR 2.49, P = 0.04), and carcinoembryonic antigen ≤ 5 ng/mL before hepatectomy (RR 2.96, P = 0.017) independently predicted the performance of repeat surgery. For patients who did not present any factors, the probability of repeat surgery was 19.6%. The addition of each subsequent factor increased the probability to 41.9, 67.8, and 84.0% (for 1, 2, and 3 factors, respectively).

Conclusions

Repeat surgery for not only intrahepatic but also extrahepatic recurrence is crucial for prolonging the survival of CRLM patients. The proposed model may help to predict the possibility of repeat surgery and provide optimal individualized treatment.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Katsunori Imai, Yo-ichi Yamashita, Yuji Miyamoto, Shigeki Nakagawa, Hirohisa Okabe, Daisuke Hashimoto, Akira Chikamoto & Hideo Baba

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  1. Katsunori Imai
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  2. Yo-ichi Yamashita
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  3. Yuji Miyamoto
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  4. Shigeki Nakagawa
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  5. Hirohisa Okabe
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  6. Daisuke Hashimoto
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Correspondence to Katsunori Imai.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Imai, K., Yamashita, Yi., Miyamoto, Y. et al. The predictors and oncological outcomes of repeat surgery for recurrence after hepatectomy for colorectal liver metastases. Int J Clin Oncol 23, 908–916 (2018). https://doi.org/10.1007/s10147-018-1273-8

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  • DOI: https://doi.org/10.1007/s10147-018-1273-8

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