Survival benefit of repeat resection of successive recurrences after the initial hepatic resection for colorectal liver metastases

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• 作者：Masaru Oba ; MD ; PhD^a ; Kiyoshi Hasegawa ; MD ; PhD^a ; Junichi Shindoh ; MD ; PhD^a ; Suguru Yamashita ; MD ; PhD^a ; Yoshihiro Sakamoto ; MD ; PhD^a ; Masatoshi Makuuchi ; MD ; PhD^b ; Norihiro Kokudo ; MD ; PhD^a ; ^{kokudo-2su@h.u-tokyo.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：159
• 期：2
• 页码：632-640
• 全文大小：550 K

文摘

Relapse is common after the resection of colorectal liver metastases (CLM); however, the optimal treatment for such recurrent disease remains uncertain. We investigated whether repeat resections for successive recurrences of CLM provide survival benefit on the postrecurrence survival.

Methods

We reviewed patients who underwent upfront, curative resection for CLM at our center during a 15-year period. Of these, 263 patients who had not received any other perioperative treatment for the metastases were eligible for our analysis. The recurrence-free survival (RFS₀) after the initial hepatic resection and after the first (n = 108), second (n = 43), and third (n = 15) repeat resections for recurrent disease were assessed (RFS_1–3). The overall survival after the initial hepatic resection and the postrecurrence survival (n = 198) also was assessed.

Results

The median RFS₀ was 0.8 years, and RFS₁, RFS₂, and RFS₃ were 1.3, 1.1, and 2.0 years, respectively. The hazard ratio for RFS for the first, second, and third resections versus the initial hepatic resection was 0.9 (95% confidence interval [95% CI] 0.7–1.1; P = .34), 1.00 (95% CI 0.7–1.4; P = .97), and 0.7 (95% CI 0.4–1.3; P = .29). The 5-year and 10-year OS rates were 54.6% and 42.2%, and the 5-year and 10-year postrecurrence survival was 34.3% and 28.6%, respectively.

Conclusion

Repeat resection in patients with recurrent disease after CLM resection is beneficial, offering the potential for cure in a small proportion of patients with recurrent disease.