Repeat hepatic surgery for colorectal cancer metastasis to the liver

C. Wright Pinson, J. Kelly Wright, William C. Chapman, C. Louis Garrard, Taylor K. Blair, John L. Sawyers

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

Objective: The authors addressed whether a repeat hepatic operation is warranted in patients with recurrent isolated hepatic metastases. Are the results as good after second operation as after first hepatic operation? Summary Background Data: Five year survival after initial hepatic operation for colorectal metastases is approximately 33%. Because available alternative methods of treatment provide inferior results, hepatic resection for isolated colorectal metastasis currently is well accepted as the best treatment option. However, the main cause of death after liver resection for colorectal metastasis is tumor recurrence. Methods: Records of 95 patients undergoing initial hepatic operation and 10 patients undergoing repeat operation for isolated hepatic metastases were reviewed for operative morbidity and mortality, survival, disease-free survival, and pattern of failure. The literature on repeat hepatic resection for colorectal metastases was reviewed. Results: The mean interval between the initial colon operation and first hepatic resection was 14 months. The mean interval between the first and second hepatic operation was 17 months. Operative modality was 0%. At a mean follow up of 33 ± 27 months, survival in these ten patients was 100% at 1 year and 88% ± 12% at 2 years. Disease-free survival at 1 and 3 years was 60% ± 16% and 45% ± 17%, respectively. After second hepatic operation, recurrence has been identified in 60% of patients at a mean of 24 ± 30 months (median 9 months). Two of these ten patients had a third hepatic resection. Survival and disease-free survival for the 10 patients compared favorably with the 95 patients who underwent initial hepatic resection. Conclusions: Repeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic operations in terms of operative mortality and morbidity, survival, disease free survival and pattern of recurrence. This work helps to establish that repeat hepatic operation is the most successful form of treatment for isolated recurrent colorectal metastases.

Original languageEnglish
Pages (from-to)765-776
Number of pages12
JournalAnnals of surgery
Volume223
Issue number6
DOIs
StatePublished - Jul 1 1996

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