Repeat Hepatic Surgery for Colorectal Cancer Metastasis to the Liver

Abstract

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

Repeat Hepatic Resection Using a Radiofrequency-Assisted Technique

“…There were no postoperative deaths, while the morbidity rate after a second resection (17%) was acceptably low and similar to the morbidity of the initial resection (29%). These results compare favourably to those of other studies on repeat hepatic resection (table 4), in which mortality rates of 0–2.5% and morbidity rates of 11–33% have been reported [15, 16,24,25,26,27,28,29,30,31,32,33,34]. Some authors have reported an increased risk of bleeding after repeat hepatic resection [16, 17, 25, 27, 29, 31, 35], a factor known to be a determinant of mortality and morbidity after resection [17, 27, 35].…”

“…In the present series, the number of repeat hepatic resections able to be performed for recurrent disease was high: 50% of recurrences after initial resection and 43% after second resection were suitable for further resection. These figures compare favourably to the 5–32% reported in other series [18, 25, 26, 28,37,38,39]. To our knowledge, this is the highest rate of repeat resection reported, which may be attributed to the ability to preserve liver parenchyma at initial and subsequent resections, thus allowing multiple recurrences to be resected whilst preserving hepatic function.…”

“…The number of liver lesions was not used as a limiting factor in deciding suitability for repeat resection. Other groups have used lesion number to restrict case selection [10, 28], but two published series have shown that the number of liver metastases does not have a significant bearing on survival after second hepatic resection [16, 29]. In the present series, 25% of the patients had multiple liver lesions (>3) at the time of their second resection compared to 83% of patients at their third resection.…”

Follow-up after Colorectal Cancer Surgery

“…Even patients with intrahepatic recurrence can undergo a second liver resection with the same result as for the first resection, i.e. a 5-year survival rate of about 30% (67,72,73).…”

Pancreaticoduodenectomy for Metastatic Renal Cell Carcinoma: Report of a Case

“…1,2 In fact, survival rates of 30%-40% have been achieved following complete resection of hepatic metastases from a colon or rectal primary. 3,4 On the other hand, surgeons are reluctant to perform pancreaticoduodenectomy to completely excise metastatic lesions in the head of the pancreas. Metastatic tumors of the pancreas are rare, accounting for less than 5% of all pancreatic malignancies, and the majority originate from primary tumors of the large bowel, lung, breast, and kidney.…”