Repeat hepatic resection as effective treatment for recurrent colorectal liver metastases

Tuttle, Todd M.; Curley, Steven A.; Roh, Mark S.

doi:10.1007/bf02303794

Cited by 96 publications

(52 citation statements)

References 27 publications

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“…Many studies have documented favorable long-term survival in highly selected patients undergoing second resection for recurrent colorectal liver metastases, with 5-year survival rates of up to 41%. [21][22][23][24] In summary, these data provide further support for longterm benefit of liver resection of hepatic colorectal metastases. Based on our experience, overall and disease-free survival is improving over time.…”

Section: Discussionmentioning

confidence: 73%

Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases

et al. 2002

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ObjectiveTo examine trends in outcomes of patients undergoing resection at a single tertiary care referral center over a 16-year period. Summary Background DataHepatic resection is considered the treatment of choice in selected patients with colorectal metastasis confined to the liver. Although a variety of retrospective studies have demonstrated improvements in short-term outcomes in recent years, changes in long-term survival over time are less well-established. MethodsData from 226 consecutive patients undergoing potentially curative liver resection for colorectal metastases between 1984 and 1999 were analyzed. Actuarial survival rates related to prognostic determinants were analyzed using the log-rank test. ResultsThe median survival for the entire cohort was 46 months, with 5-and 10-year survival rates of 40% and 26% respectively.Ninety-three patients operated on between 1984 and 1992 were found to have an overall survival of 31% at 5 years, compared to 58% for the 133 patients operated on during the more recent period (1993)(1994)(1995)(1996)(1997)(1998)(1999). Both overall and diseasefree survival were significantly better in the recent time period compared with the earlier period on both univariate and multivariate analyses. Other independent factors associated with improved survival included number of metastatic tumors Յ 3, negative resection margin, and CEA Ͻ 100. Comparisons were made between time periods for a variety of patient, tumor and treatment-related factors. Among all parameters studied, only resection type (anatomical versus nonanatomical), use of intraoperative ultrasonography, and perioperative chemotherapy administration differed between the early and recent time periods. ConclusionsLong-term survival following liver resection for colorectal metastases has improved significantly in recent years at our institution. Although the reasons for this survival trend are not clear, contributing factors may include the use of newer preoperative and intraoperative imaging, increased use of chemotherapy, and salvage surgical therapy.Hepatic resection has gained acceptance as the most effective therapy for patients with colorectal metastases confined to the liver. Advances in surgical planning, operative technique, and perioperative care have resulted in improved short-term outcomes, with experienced centers now reporting in-hospital mortality rates of less than 5%, even with major resections. 1-5Long-term survival and potential for cure following surgical resection for hepatic colorectal metastases have been demonstrated in numerous uncontrolled studies. In most series, the overall 5-year survival rate reported following hepatic resection with curative intent ranges from 25%-37%, and with median survival of between 24 and 40 months.1-3,6 -10 As hepatic resections have become safer and indications have broadened, there are increasing expectations regarding assessment of trends in long-term patient outcomes. Although some improvement in survival are being reported in more recent series compared with th...

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Section: Discussionmentioning

confidence: 73%

Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases

et al. 2002

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“…All efforts should be made to eliminate the hepatic lesions after controlling the loco-regional disease and ruling out extrahepatic tumor spread. In such cases there are well documented reports demonstrating a 5-year survival of 20%-40% [1][2][3][4][5][6] , and 20%-30% when a re-resection has been executed in highly selected individuals [6][7][8][9] . The indications and criteria of patient selection for liver surgery due to metachronous colorectal metastases have been clarified in numerous excellent papers [14][15][16] .…”

Section: Discussionmentioning

confidence: 99%

“…Even re-resections of liver metastases are rewarded with a 5 year-survival of 20%-30% and should be carried out in selected patients [6][7][8][9] . Many aspects of surgical strategies for the management of colorectal liver metastases have been extensively analyzed [10][11][12][13][14][15] and patient selection has been elucidated [1,3,7,[15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Surgical approaches of resectable synchronous colorectal liver metastases: Timing considerations

Vassiliou

Arkadopoulos²,

Theodosopoulos³

et al. 2007

WJG

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AIM:To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases. METHODS:From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases. RESULTS:In two-stage procedures more transfusions were required (4 ± 1.5 vs 2 ± 1.8, pRBCs, P < 0.05).Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 ± 8 vs 12 ± 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series. CONCLUSION:Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon

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“…The presence of recurrent liver metastases was historically considered to have a poor prognosis and routine screening for patients having undergone resection of colorectal liver metastases was felt not to be justified by analysis of cost to benefit ratio (Biggs and Ballantyne, 1994;Beard et al, 2000). However, recent studies have shown a 35 -40% survival at 5 years following surgery for recurrent liver metastases (Tuttle et al, 1997;Yamamoto et al, 1999a;Muratore et al, 2001;Suzuki et al, 2001;Yamada et al, 2001a). These results reflect a better outcome with a more aggressive approach towards the treatment of colorectal liver metastases and careful follow-upof patients following resection of the liver metastases is therefore essential.…”

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confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18 -60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1 -21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (Po0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.

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Repeat hepatic resection as effective treatment for recurrent colorectal liver metastases

Abstract: Repeat liver resection for recurrent colorectal metastases (a) can be performed safely with acceptable mortality and morbidity rates and (b) may result in long-term survival in some patients.

Cited by 96 publications

References 27 publications

Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases

Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases

Surgical approaches of resectable synchronous colorectal liver metastases: Timing considerations

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

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