Efficacy of repeat hepatectomy for recurrence following curative hepatectomy for colorectal liver metastases: A Retrospective Cohort Study of 128 patients.
BACKGROUND
Despite improvements in surgery and chemotherapy, most patients develop recurrence after initial hepatectomy for colorectal liver metastasis (CRLM). Following initial hepatectomy for CRLM, patterns and surgical management of recurrence have not been widely reported.


MATERIALS AND METHODS
We identified 128 patients who underwent hepatic resection for CRLM between January 2000 and December 2012. Demographics, operative data, site of recurrence, and long-term survival data were collected and analyzed. Patients were stratified into 3 groups based on their site of recurrence as intrahepatic, intra- and extrahepatic, and extrahepatic. In addition, the influence of potential factors on overall survival (OS) in patients with only liver relapse was analyzed through univariate and multivariate analysis.


RESULTS
After curative initial hepatectomy, 87 (68.0%) patients had a recurrence: 33 in the intrahepatic group, 11 in the intra- and extrahepatic group, and 43 in the extrahepatic group. The OS for the intra- and extrahepatic group was significantly lower than that for the intrahepatic group. In the intrahepatic group, disease-free interval (DFI) < 12 months and non-repeat hepatectomy were independent poor prognostic factors. Carcinoembryonic antigen (CEA) at the time of hepatectomy was significantly higher in DFI < 12 group than in the DFI ≥ 12 group.


CONCLUSION
Patterns of recurrence following initial hepatectomy for CRLM have important implications for OS. In the intrahepatic recurrence group, short DFI was correlated with high CEA at hepatectomy, and was a poor prognostic factor.
['Hashimoto|Masakazu|M|', 'Kobayashi|Tsuyoshi|T|', 'Ishiyama|Kohei|K|', 'Ide|Kentaro|K|', 'Ohira|Masahiro|M|', 'Tahara|Hiroyuki|H|', 'Kuroda|Shintaro|S|', 'Hamaoka|Michinori|M|', 'Iwako|Hiroshi|H|', 'Okimoto|Masashi|M|', 'Ohdan|Hideki|H|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002272:Carcinoembryonic Antigen D015179:Colorectal Neoplasms D005260:Female D006498:Hepatectomy D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D011379:Prognosis D012086:Reoperation D012189:Retrospective Studies
Repeat hepatectomy Recurrence Colorectal liver metastases Prognostic factor