<p>Repeat procedures for recurrent colorectal liver metastases: analysis of long-term liver regeneration and outcome</p>

Abstract

Background and aim: Repeat hepatectomy is increasingly performed for the management of recurrent colorectal liver metastases (CRLM). The aim of this study was to evaluate long-term functional liver volume (FLV) after a second hepatic procedure and to measure survival outcome. Methods: In this retrospective cohort study, patients treated for recurrent CRLM in the years 2005–2015 at two liver centers were included. Total FLV was calculated before the first procedure and before and after the second procedure. Overall survival was calculated. Results: Eighty-two patients were identified. The median follow-up was 53 (40–71) months from the first procedure. The median interval between first and second procedure was 13 (8–22) months. The initial FLV was 1584 (1313–1927) mL. The FLV was 1438 (1204–1896) mL after the first procedure and 1470 (1172–1699) mL after the second procedure ( P <0.001). After the second procedure, a total of ten patients (12%) had a residual liver volume of less than 75% of the initial liver volume. The 5-year overall survival was 37 (26–54)% after the second procedure. Conclusion: Small changes in FLV were found after two hepatic procedures but with considerable inter-individual variation. Patients selected for a repeated hepatic procedure for recurrent CRLM had an acceptable survival.

Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group

“…Although the items of agreement aimed to cover both patients with and without a history of local therapy for CRLM, the reported evidence mainly focused on the first metastatic episode. Hence, the outcomes are less applicable to patients with distant recurrences in the liver, given the presumed higher complexity of surgical procedures in a previously accessed abdominal cavity and given the often reduced liver remnant volume [101]. One potential shortcoming of our study was the underrepresentation of some professions in the multidisciplinary expert panel (two radiation oncologists, two medical oncologists and one technical physician, compared to 19 surgeons and 21 interventional radiologists), which potentially weakens the generalizability of the agreements.…”

Recurrence After Liver Resection of Colorectal Liver Metastases: Repeat Resection or Ablation Followed by Hepatic Arterial Infusion Pump Chemotherapy

“…The safety and effectiveness of repeat hepatectomy in selected patients have been reported in several studies. [1][2][3][4][5][6] With proper selection, repeat hepatectomy is considered safe, with similar mortality and morbidity to the initial hepatectomy. In well-selected patients, median OS after second hepatectomy has been reported to range from 32 to 43 months, 2,6,8,17 and 5-year OS rates ranged from 30% to 48%.…”

“…In well-selected patients, median OS after second hepatectomy has been reported to range from 32 to 43 months, 2 , 6 , 8 , 17 and 5-year OS rates ranged from 30% to 48%. 3 , 6 , 8 A systematic review and meta-analysis of 22 studies, including 1610 patients, found a median OS after hepatectomy for recurrent disease of 35 months and a 5-year OS of 42%. 6 Notably, the median OS of patients not treated with adjuvant HAIP chemotherapy in our study was 57 months, and the 5-year OS was 47%.…”

“…Repeat resection of colorectal liver metastases (CRLM) is safe and feasible. [1][2][3][4][5][6] Nearly half of all patients undergo re-resection and/or ablation for intrahepatic recurrences after initial resection of CRLM. 2,7 Previous studies have demonstrated favorable overall survival (OS) for highly selected patients after repeat hepatectomy, with a 5-year OS of almost 50%.…”

The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

“…Butte et al and Andreou and colleagues reported no difference in effectiveness of surgical results [47,49] and the future liver remnant volume did not differ between patients with and without chemotherapy according to Valdimarsson and colleagues [62]. However, Hallet and colleagues found a more congested and friable liver parenchyma after NAC before repeat local treatment, which may increase the risk of bleeding during surgery [50] (Tables 3 and 4).…”