RECURRENT TUMOR AFTER RESECTION OF HEPATIC METASTASES FROM COLORECTAL-CARCINOMA - LOCATION AND TIME OF DISCOVERY AS DETERMINED BY CT

OBJECTIVE. Despite studies showing increased survival rates for patien ts after surgical resection of hepatic metastases, recurrences occur i n 75% of treated patients. The purpose of this study was to determine the location and time of discovery of recurrent tumor on CT scans afte r resection of hepatic metastases from colorectal carcinoma. MATERIALS AND METHODS. In a g-year period, 32 patients (16 men and 16 women) wh o had undergone partial hepatic resection for colorectal metastases ha d follow-up CT at our institution. A total of 125 CT examinations of t he chest and abdomen were retrospectively reviewed for the presence an d location of recurrent disease. Recurrence was either confirmed by bi opsy (n = 12) or presumed on the basis of growth of new lesions (n = 1 7). RESULTS. With a mean follow-up of 22 months (range, 1-60 months), recurrence was found at 29 sites in 25 patients. Thirteen sites were h epatic, and 16 were extrahepatic. Three patients had both hepatic and pulmonary disease. Recurrence within the liver was away from surgical margins in 11 (85%) of 13 patients at 14 +/- 7 months and adjacent to a surgical margin in the remaining two patients (15%) at 17 +/- 1 mont hs. Extrahepatic recurrences were discovered in the lung in 11 (69%) o f 16 patients at 21 +/- 12 months; in an adrenal gland in two patients (13%) at 19 +/- 5 months; in lymph nodes of the porta hepatis in one patient (6%) at 11 months; at the primary colonic anastomosis in one p atient (6%) at 3 months; and in a retroperitoneal lymph node in the re maining patient (6%) at 12 months. CONCLUSION. Surgery was effective i n treating the preoperatively detected hepatic metastases. Only two of 25 patients had recurrence related to a hepatic surgical margin. Most recurrences occur more than 1 year after surgery, most often in lung or liver away from surgical margins, and they probably represent small metastases undetectable with current preoperative or intraoperative t echniques.