Repeat hepatectomy for cancer

Elias, D.; Lasser, P; Hoang, Jemmie; Leclère, J.; Debaenet, B.; Bognel, C; Spencer, Andrew; Rougier, P

doi:10.1002/bjs.1800801223

Cited by 92 publications

(51 citation statements)

References 10 publications

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“…6'7"12"16" 9 Ten to 40% of these patients with isolated recurrence undergo second resections. 12,14,16,19,21 In our experience, 71% of patients recurred at a mean of 13 months, 55% involving the liver and 33% involving the liver alone. Nineteen percent of those with isolated recurrence underwent a second hepatic operation.…”

Section: Resultsmentioning

confidence: 99%

Repeat Hepatic Surgery for Colorectal Cancer Metastasis to the Liver

Pinson

Wright²,

Chapman³

et al. 1996

Annals of Surgery

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ObjectiveThe authors addressed whether a repeat hepatic operation is warranted in patients with recurrent isolated hepatic metastases. Are the results as good after second operation as after first hepatic operation? Summary Background DataFive-year survival after initial hepatic operation for colorectal metastases is approximately 33%. Because available alternative methods of treatment provide inferior results, hepatic resection for isolated colorectal metastasis currently is well accepted as the best treatment option. However, the main cause of death after liver resection for colorectal metastasis is tumor recurrence. MethodsRecords of 95 patients undergoing initial hepatic operation and 10 patients undergoing repeat operation for isolated hepatic metastases were reviewed for operative morbidity and mortality, survival, disease-free survival, and pattern of failure. The literature on repeat hepatic resection for colorectal metastases was reviewed. ResultsThe mean interval between the initial colon operation and first hepatic resection was 14 months. The mean interval between the first and second hepatic operation was 17 months. Operative mortality was 0%. At a mean follow-up of 33 ± 27 months, survival in these ten patients was 100% at 1 year and 88% ± 12% at 2 years. Disease-free survival at 1 and 3 years was 60% ± 16% and 45% ± 17%, respectively. After second hepatic operation, recurrence has been identified in 60% of patients at a mean of 24 ± 30 months (median 9 months). Two of these ten patients had a third hepatic resection. Survival and disease-free survival for the 10 patients compared favorably with the 95 patients who underwent initial hepatic resection. ConclusionsRepeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic operations in terms of operative mortality and morbidity, survival, disease-free survival, and pattern of recurrence. This work helps to establish that repeat hepatic operation is the most successful form of treatment for isolated recurrent colorectal metastases. 765

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Section: Resultsmentioning

confidence: 99%

Repeat Hepatic Surgery for Colorectal Cancer Metastasis to the Liver

Pinson

Wright²,

Chapman³

et al. 1996

Annals of Surgery

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“…Repeat hepatectomy is the gold standard for treating recurrent liver metastases (16)(17)(18) with reported low local recurrence. However, repeat hepatectomy is technically demanding, with a mortality rate close to 2% (17).…”

Section: Discussionmentioning

confidence: 99%

“…the exact place of RFA in the treatment of recurrent liver metastases is still debated because there is no solid evidence on the impact of RFA on overall recurrence and long-term survival. Repeated surgery, when amenable, is still considered the first treatment option in that setting (14)(15)(16)(17)(18), but the risk of complications is higher than after primary liver resection. therefore, percutaneous RFA could be an attractive alternative treatment in selected patients with recurrent CLM due to its lower mortality and morbidity rates.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

et al. 2014

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Introduction: to assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases.Patients and Methods: between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. a total of 91 lesions were treated. the mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. in 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure.Results: the morbidity rate was 18.7%, and there were no post-procedural deaths. distant extrahepatic recurrence appeared in 50% of the patients. local recurrence at the site of ablation appeared in 18% of the lesions. local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. the size of the lesions (more than 3 cm) was an independent risk factor for local recurrence (p < 0.05). Survival rates at 1, 3, and 5 years were 94.5%, 65.3%, and 21.7%, respectively. Discussion: radiofrequency ablation is a safe procedure and allows local tumor control in lesions less than 30 mm (local recurrence of 6%) and provides survival benefits in patients with recurrent colorectal liver metastases.

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“…89,90,[93][94][95] As the safety and efficacy of liver resection has been increasingly accepted, repeat resections are also more commonly being performed. Although re-resections only account for 3% to 11% of all liver resections in experienced centers, [94][95][96][97] the number of repeat resections at major centers may be increasing. Bismuth et al 93 reported a significant increase in the percent of liver resections that are repeat resections at their institution from 6% (6 of 105) from 1983 to 1989 compared with 28% (49 of 177) from 1990 to 1994.…”

Section: Results Of Liver Resection For Colorectal Metastasesmentioning

confidence: 99%

“…Postoperative complications range from 15% to 32%, somewhat higher when compared with initial resections. [94][95][96] This higher morbidity is in part the result of increased risk for bleeding related to perihepatic adhesions and the frequent limited ability to achieve selective vascular control. The selection criteria of patients for re-resection for colorectal liver metastases are similar to those for initial resection.…”

Section: Results Of Liver Resection For Colorectal Metastasesmentioning

confidence: 99%

Management of hepatic metastases

Choti

Bulkley

1999

Liver Transpl

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Although the liver is the most common site of metastatic disease from a variety of tumor types, isolated hepatic metastases most commonly occur from colorectal cancer and, less frequently, from neuroendocrine tumors, gastrointestinal sarcoma, ocular melanoma, and others. Complete evaluation of the extent of metastatic disease, both intrahepatically and extrahepatically, is important before considering treatment options. Based on a preponderance of uncontrolled studies for hepatic metastatic colorectal carcinoma, surgical resection offers the only potential for cure of selected patients with completely resected disease, with 5-year survival rates of 25% to 46%. Systemic and hepatic arterial infusion chemotherapy may be useful treatment options in patients with unresectable disease and possibly as an adjuvant treatment after liver resection. Other techniques of local tumor ablation, including cryotherapy and radiofrequency ablation, although promising, remain unproved. Management of hepatic metastases from neuroendocrine tumors and other noncolorectal primary tumors should be individualized based on the patient's clinical course, extent of disease, and symptoms. Copyright 1999 by the American Association for the Study of Liver DiseasesA s many as 50% of the patients with a primary malignancy will eventually develop metastases in the liver, a percentage greater than for any other organ, including the lung. Although primary tumors that drain principally into the portal circulation are more likely than others to develop hepatic metastases, many tumors arising in other sites, such as the breast and lung, also commonly develop hepatic metastases. Although the liver represents a common site of spread from many of these solid tumors, isolated hepatic metastases most commonly occur from colorectal and neuroendocrine tumors. Other less common malignancies also can metastasize predominantly to the liver. For most other solid malignancies, the pattern of metastatic disease is most often that of generalized dissemination. Colorectal MetastasesCancer of the colon and rectum is the third most commonly diagnosed cancer in the United States. An estimated 131,600 new cases will have been discovered in 1998, comprising 11% of new cancer diagnoses. 1 An estimated 56,500 deaths will occur from colorectal cancer that year, comprising 10% of all cancer deaths. 1 Although mortality from largebowel cancer has been improving over the past 30 years, largely because of improvements in early detection, diagnosis, and treatment, approximately 50% of the patients with colorectal cancer eventually die of their neoplastic disease. 1 The liver is the most commonly involved organ in patients with metastatic colorectal cancer. Approximately 20% of these patients have clinically recognizable liver metastases at the time of their primary diagnosis. 1,2 After resection of a primary colorectal cancer in the absence of apparent metastatic disease, approximately 50% of the patients will subsequently manifest metastatic liver disease. Given these figures,...

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Repeat hepatectomy for cancer

Cited by 92 publications

References 10 publications

Repeat Hepatic Surgery for Colorectal Cancer Metastasis to the Liver

Repeat Hepatic Surgery for Colorectal Cancer Metastasis to the Liver

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

Management of hepatic metastases

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