REPEAT HEPATIC RESECTIONS FOR METASTATIC COLORECTAL-CANCER

Objective The authors weighed the risks and benefits of repeal liver r esections for colorectal metastatic disease. Method In the 6-year peri od between January 1985 and June 1991, 499 patients underwent liver re sections for colorectal metastases al the Memorial Sloan-Kettering Can cer Center. Of these, 25 patients had repeat surgical resections for i solated recurrent disease to the liver. The clinical data for these pa tients were reviewed. Results The median interval between the two rese ctions was 11 months. There were no perioperative deaths, and the comp lication rate was 28%. Median follow-up after the second liver resecti on is 19 months, with median survival of 17 months for nonsurvivors. A lthough the median survival after the second resection is 30 months, 2 0 of the 25 patients have had recurrences with a median disease-free i nterval of only 9 months. No characteristic of primary or metastatic d isease predicted outcome, including time between presentation of the p rimary and development of liver metastases, disease-free interval afte r the first liver resection, and bilobar liver involvement. Conclusion s Although repeat liver resections can be performed safely and improve survival, the likelihood of cure from such resection therapy is low. This likelihood of further recurrences encourage studies of adjuvant o r alternative treatments of this population.