REPEAT HEPATECTOMY FOR RECURRENT COLORECTAL METASTASES

Recurrence rates after hepatic resection in patients with colorectal m etastases are reported to range from 47% to 80%. Hepatic recurrence is seen in 35% to 50% of patients. Aggressive surgical resection appears to be a worthwhile treatment in patients,vith recurrent hepatic metas tases to promote longer patient survival because surgical resection re mains the only curative therapy available. This is a retrospective rev iew of our experience with 15 patients undergoing repeat hepatic resec tion culled from 67 patients undergoing initial hepatectomy for metast atic colorectal cancer. Of 67 patients who underwent hepatectomy for c olorectal hepatic metastases, 33 developed hepatic recurrence at a med ian interval of 23 months (range 1-176 months) after the first hepatec tomy. The second hepatectomy was performed in 15 patients 5 to 29 mont hs after the first hepatectomy, with no mortality. The mean operating time and blood Loss at the second hepatectomy were similar to those at the first hepatectomy. The mean hospital stay at the second hepatecto my was significantly shorter than that at the first hepatectomy. The c umulative survival rate for the 15 patients was 42.4% at 3 years and 2 1.2% at 5 years, respectively, which compared favorably with the survi val rate of the 67 patients who underwent initial hepatectomy. Patient s who underwent the second hepatectomy had significantly higher surviv al rates from the first hepatectomy than the 18 patients with unresect able hepatic recurrence. Repeat hepatectomy can be performed safely an d provides long-term survival rates similar to those of first hepatect omies. In appropriately selected patients, repeat hepatectomy for colo rectal metastases is a worthwhile treatment.