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A SYSTEMATIC REVIEW ON THE EFFICACY OF REPEAT HEPATECTOMY FOR RECURRENT LIVER METASTASES FROM COLORECTAL CARCINOMA
Author(s) -
Sim J.,
Yan T. D.,
Black D.,
Morris D. L.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04131_11.x
Subject(s) - medicine , hepatectomy , observational study , perioperative , surgery , oncology , gastroenterology , resection
Purpose The objectives of this systematic review were to critically appraise the quantity and quality of current clinical evidence and demonstrate the efficacy of repeat hepatectomy for CRLM. Methodology Electronic searches for relevant studies published in peer‐reviewed journals on repeat hepatectomy for recurrent CRLM prior to September 2006 were performed on six databases. All articles identified were assessed with application of selection criteria. The quality of each included study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results. Results Seventeen studies with more than 20 patients were included for quality appraisal and data extraction. These 17 studies consisted of two multi‐institutional, one bi‐institutional and 14 single‐center observational studies. The overall perioperative morbidity rate ranged from 7–30% and mortality rate varied from 0–5%. The overall median survival since initial hepatectomy was 26 to 73 months. The overall median survival since the repeat hepatectomy ranged from 23 to 56 months, with 3‐ and 5‐year survival of 24–68% and 21–49%, respectively. The median disease‐free survival ranged from 9 to 52 months, with 3‐ and 5‐year disease‐free survival of 16–68% and 16–48%, respectively. After repeat hepatectomy the rates of recurrence in the liver and at an extra‐hepatic site were 15–67% and 27–64%, respectively. Conclusions The current literature suggests that repeat hepatectomy is associated with a prolonged survival for recurrent CRLM. Although all studies were observational case series, repeat hepatectomy is justified in selected patients, as there is a lack of evidence for alternative treatment.