REPEAT HEPATIC RESECTION FOR RECURRENT COLORECTAL-CANCER

Recurrence in the liver following hepatic resection for metastatic col orectal carcinoma is a predictable phenomenon, occurring in about two- thirds of patients who develop recurrence. There are few data, however , about the value of repeated hepatic resection in patients who have a recurrence in the liver following initial resection of their hepatic metastases. We have reviewed our experience with 10 patients (of whom 9 were evaluable), culled from a series of 74 patients who had an init ial hepatic resection for metastastic colorectal carcinoma. There were seven men and two women, mean age 52 (range 34-75 years). Duke's stag es of the primary cancer were B1 in two patients, B2 in one patient, a nd C2 in six patients. Most of the patients had elevated carcinoembryo nic antigen (CEA) and constitutional symptoms as indications for the s econd-look procedure. There was one surgical death due to hepatic fail ure in a patient who required a trisegmentectomy. The average interval between the first and second hepatic resections was 21 months. The es timated 1- and 5-year actuarial survivals from the second liver resect ion were 78% and 23%, respectively. The median survival was 41 months from the first resection (range 14-100 months) and 16 months from the second resection (range 0-92 months). In conclusion, repeat hepatectom y for recurrent liver metastases is a viable option for the well selec ted patient. It is a low risk surgical procedure and may augment survi val in the patient with Hell documented metastases limited to the live r.