Survival after repeat hepatic resection for recurrent colorectal metastases

BACKGROUMD/AIMS: This is a retrospective study examining survival of patien ts undergoing repeat hepatic resection for recurrent colorectal metastases. METHODOLOGY: The records of 41 patients undergoing hepatic resection for me tastatic colorectal cancer were reviewed. Curative resections (negative res ection margin and no extrahepatic disease) were attempted in all patients. Recurrence developed in 26 (63%) patients, with disease being confined to t he liver in 16 (39%) patients. Tell of them (24%) underwent hepatic resecti on and make up the study population. RESULTS: Ten patients (4 women, 6 men; mean age: 62 years, range: 50-82 yea rs) developed recurrence confined to the liver at the median interval of 16 months (range: 5-34 months) after the first hepatectomy. In 6 patients the recurrent cancer(s) involved both the area near the resection line and rem ote sites from the site of the first hepatic resection. In 3 patients recur rent cancer(s) was located at sites remote from the first liver resection. In 1 patient the recurrent cancer was located in the same area as the origi nal hepatic resection. Three formal hepatectomies and seven non-anatomical (wedge) resections were performed. The mean blood loss was 900cc (range: 10 0-2700cc); the mean hospital stay was 19 days (range: 8-34 days). There was no perioperative mortality. Morbidity was 20%. Four patients died of recur rent disease, with a mean disease-free survival of 13 months (range: 5-21 m onths). Two patients had a second recurrence resected at 10 and 24 months, respectively, after the second hepatic resection. One of these 2 patients h ad a fourth hepatic resection for hepatic recurrence and is still alive wit h no evidence of disease. Six patients are alive, 4 of them without evidenc e of disease, with a median follow-up time of 30 months (range: 22-64 month s). Actuarial 4-year specific survival was 44%. Actuarial disease-free surv ival at 4 years was 18%. CONCLUSIONS: In appropriately selected patients, repeat hepatic resection f or colorectal metastases is a worthwhile treatment. Mortality, morbidity, a nd survival are similar to those following the initial resection.