Aggressive surgical approach to recurrent tumors after hepatectomy for metastatic spread of colorectal cancer to the liver

Background. Liver resection is currently accepted as the only potential cur e for patients with metastases of colorectal tumors in the liver. However, cancer will recur in more than 70% of patients. Methods. In the 7 years to December 1997 60 patients underwent liver resect ions for colorectal metastases at our institute. Of these, 20 patients had repeated surgical resections for recurrent disease of the liver and other o rgans. Another 2 patients had undergone previous hepatectomy elsewhere. The clinical data for these patients were reviewed. Results. The median interval between the 2 resections was 16 months. Eighte en hepatectomies, 6 lung resections, and I pancreatoduodenectomy were perfo rmed in 22 patients. Operative mortality and complication rates were 0% and 18%, respectively. At a median follow-up of 25 months after repeated resec tion, the survival rate in these patients was 73% at 2 years (12 of IG eval uable patients are surviving) and 22% at 5 years (2 of 10 evaluable patient s are surviving); the median survival time was 44 months. Conclusions. Repeated resections for recurrent colorectal metastases yield comparable results to first liver resections in operative mortality and mor bidity rates, survival time, and pattern of recurrence. Although the number of patients surviving more than 5 years is still limited, the absence of o ther proven treatments supports the concept of an aggressive reresectional approach for these patients.