Repeat Hepatectomy for Early Recurrence of Colorectal Liver Metastases-Prognostic Impacts Assessed from the Recurrence Pattern.

Abstract

It is unclear how early liver recurrence negatively affects survival in patients undergoing surgery for colorectal liver metastases (CLM) and whether to perform re-hepatectomy for early recurrence is still controversial. We aimed to evaluate the prognostic value of re-hepatectomy for early recurrence of CLM. We reviewed 634 patients undergoing initial hepatectomy for CLM between 2004 and 2015. In 131 patients (20.7%), liver recurrence occurred within 6 months after surgery (early recurrence group [ER]). Recurrence pattern and survivals of ER were compared with those of 150 patients (23.7%) who had liver recurrence more than 6 months after surgery (late recurrence group [LR]). Re-hepatectomy was indicated for resectable disease regardless of the timing of recurrence without using preoperative chemotherapy. The 5-year overall survival (OS) rates after initial hepatectomy in ER (24.0%) were worse than those in LR (57.7%, p < 0.01). Although the incidence of concomitant extrahepatic recurrence was not different between ER and LR, the rate of re-hepatectomy for recurrence confined to the liver in ER (72.5% [58/80]) was lower than that in LR (88.9% [96/108], p < 0.01). In ER, re-hepatectomy was found to independently improve survival (HR: 6.479, p < 0.01), offering the 5-year OS rate after re-hepatectomy of 45.2%. The sites and timing of re-recurrence after re-hepatectomy were not different between ER and LR. Impaired survival of early liver recurrence is attributed to extensive liver recurrence. However, re-hepatectomy indicated based on resectability is associated with improved survival in patients with early recurrence, tempering the re-recurrence mode.