REPEAT HEPATIC SURGERY FOR COLORECTAL-CANCER METASTASIS TO THE LIVER

Objective The 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 oper ation? Summary Background Data Five-year survival after initial hepati c operation for colorectal metastases is approximately 33%. Because av ailable alternative methods of treatment provide inferior results, hep atic resection for isolated colorectal metastasis currently is well ac cepted as the best treatment option. However, the main cause of death after liver resection for colorectal metastasis is tumor recurrence. M ethods Records of 95 patients undergoing initial hepatic operation and 10 patients undergoing repeat operation for isolated hepatic metastas es were reviewed for operative morbidity and mortality, survival, dise ase-free survival, and pattern of failure. The literature on repeat he patic resection for colorectal metastases was reviewed. Results The me an interval between the initial colon operation and first hepatic rese ction was 14 months. The mean interval between the first and second he patic operation was 17 months. Operative mortality was 0%. At a mean f ollow-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 hep atic 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. Conclusions Repeat hepatic operation for r ecurrent colorectal metastasis to the live, yields comparable results to first hepatic operations in terms of operative mortality and morbid ity, survival, disease-free survival, and pattern of recurrence. This work helps to establish that repeat hepatic operation is the most succ essful form of treatment for isolated recurrent colorectal metastases.