REPEAT HEPATECTOMY FOR COLORECTAL LIVER METASTASES

Objective The authors assess the long-term results of repeat hepatecto mies for recurrent metastases of colorectal cancer and determine the f actors that can predict survival. Summary Background Data Safer techni ques of hepatic resection have allowed surgeons to consider repeat hep atectomy for colorectal metastases in an increasing number of patients . However, higher operative bleeding and increased morbidity have been reported after repeat hepatectomies, and the long-term benefit of the se procedures needs to be evaluated. Study Population Sixty-four patie nts from a group of 243 patients resected for colorectal liver metasta ses were submitted to 83 repeal hepatectomies (64 second, 15 third, an d 4 fourth hepatectomies). Combined extrahepatic surgery was performed in 21 (25%) of these 83 repeat hepatectomies. Results There was no in traoperative or postoperative mortality. Operative bleeding was not si gnificantly increased in repeat hepatectomies as compared to first res ections. Morbidity and duration of hospital stay were comparable to fi rst hepatectomies. Overall and disease-free survival after a second he patectomy were 60% and 42%, respectively, at 3 years and 41% and 26%, respectively, at 5 years. Factors of prognostic value on univariate an alysis included the curative nature of first and second hepatectomies (p=0.04 and p=0.002, respectively), an interval between the two proced ures of more than 1 year (p=0.003), the number of recurrent tumors (p= 0.002), serum carcinoembryonic antigen levels (p=0.03), and the presen ce of extrahepatic disease (p=0.03). Only the curative nature of the s econd hepatectomy and an interval of more than 1 year between the two procedures were independently related to survival on multivariate anal ysis. Conclusions Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies, with no mortality and c omparable morbidity. Combined extrahepatic surgery can be required to achieve tumor eradication. Repeat hepatectomies appear worthwhile when potentially curative.