REPEAT RESECTION OF RECURRENT HEPATIC METASTASES - IMPROVEMENT IN PROGNOSIS

Objective: To find out if resection of recurrent hepatic metastases im proves survival. Design: Retrospective study. Setting: University hosp ital, Germany. Subjects: 25 patients who had recurrent metastases afte r radical resection of hepatic metastases from colorectal and other pr imary carcinomas. Interventions: Repeat liver resection with the inten tion to cure. Limited hepatic resections were preferred if they could be done without loss of radicality. Main outcome measures: Operative m orbidity and mortality, survival time after second hepatic resection, analysis of possible prognostic factors. Results: Hemihepatectomy was done for 4 patients, and infiltration of the diaphragm led to extended resections in a further 4. Locoregional recurrence of rectal carcinom a together with a solitary pulmonary metastases in another patient wer e removed simultaneously. The remainder were limited resections. Seven teen procedures were regarded as radical. There were no operative deat hs, and five patients developed minor complications. Actuarial surviva l rates after radical repeat liver resections were 94% after one year, 53% after two years, and 24% after three years. Radicality was the ma in prognostic factor of survival. Conclusion: Repeat hepatic resection s seem to improve prognosis and are recommended in patients with recur rent metastases confined to the liver.