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Repeat hepatectomy for colorectal liver metastases: A worthwhile operation?
Author(s) -
Muratore Andrea,
Polastri Roberto,
Bouzari Hedayat,
Vergara Vincenzo,
Ferrero Alessandro,
Capussotti Lorenzo
Publication year - 2001
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/1096-9098(200102)76:2<127::aid-jso1023>3.0.co;2-z
Subject(s) - medicine , contraindication , hepatectomy , carcinoembryonic antigen , colorectal cancer , univariate analysis , surgery , survival rate , surgical oncology , gastroenterology , resection , multivariate analysis , cancer , pathology , alternative medicine
Background and Objectives After curative resection of hepatic colorectal metastases, 10–20% of patients experience a resectable hepatic recurrence. We wanted to assess the expected risk‐to‐benefit ratio in comparison to first hepatectomy and to determine the prognostic factors associated with survival. Methods Twenty‐nine patients from a group of 152 patients resected for colorectal liver metastases underwent 32 repeat hepatectomies. Results In‐hospital mortality was 3.5% (1/29 patients); the morbidity after repeat hepatectomy was lower than that after first hepatic resection. Combined extrahepatic surgery was performed on 34.5% of repeat hepatectomies vs. 6.9% of first hepatectomies (P = 0.01). Overall actuarial 3‐year survival was 35.1%: four patients have survived more than 3 years and one survived for more than 5 years. The number of hepatic metastases and the carcinoembryonic antigen (CEA) serum levels were significant prognostic factors on univariate analysis. The synchronous resection of hepatic and extrahepatic disease was not associated with a lower survival rate when compared with that of patients without extrahepatic localization: three patients of the former group are alive and disease‐free at more than 2 years. Conclusions Repeat hepatic resection can provide long‐term survival rates similar to those of first liver resection, with comparable mortality and morbidity. The presence of resectable extrahepatic disease must not be an absolute contraindication to synchronous hepatectomy because long‐term survival is possible. J. Surg. Oncol. 2001;76:127–132. © 2001 Wiley‐Liss, Inc.