REPEAT LIVER RESECTIONS FROM COLORECTAL METASTASIS

Background. A retrospective multiinstitutional study was performed to assess survival benefits of patients undergoing repeat liver resection for colorectal metastasis. An updated report is presented here. Metho ds. The series comprised 170 patients from 20 different institutions a round the world. Mean age of patients was 58 years (range, 28 to 84 ye ars). The mean and median follow-up were 29 and 25 months, respectivel y. Results. Three- and 5-year overall survival rates were 45% and 32%, respectively. The Dukes' stage of the primary tumor showed a 34% 5-ye ar survival rate for those patients with negative nodes and 30% if nod es were positive (p = 0.42). The disease-free interval between liver r esections showed a better outcome for those who had undergone repeated liver resections less than 1 year from the first liver resection (42% versus 23% 5-year survival rates); the difference was not significant (p = 0.58). The number of metastases Sound and resected at second pro cedures did not show significant differences in survival and was proba bly due to selection criteria. Anatomic resections reached a better 5- year survival rate (39%) than wedge resections (21%). The difference w as not statistically significant (p = 0.2). The presence of extrahepat ic disease and residual liver tumor left behind when repeat liver rese ction was performed were the most important prognostic variables in su rvival. Patients with extrahepatic disease had 19% 5-year survival rat e, whereas those without disease outside the liver had 36% 50-year sur vival rate (p = 0.09). Patients with complete resections and those wit h residual liver disease after repeat resections had 36% and 17% 5-yea r survival rates, respectively (p = 0.01). Presence of postoperative m orbidity after second liver resections did not show a significant nega tive impact in survival (p = 0.70). Adjuvant therapies were not widely used after liver resections and did not seem to improve prognosis of patients who were treated (39% versus 29% 5-year survival rates, p = 0 .9). Conclusions. Repeat liver resections for colorectal metastasis is a justified approach because surgery remains the only potentially cur ative treatment. These procedures are relatively safe with low morbidi ty and mortality rates. Long-term survival (32%) can only be achieved in selected patients.