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Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases Ahmad A; Chen SL; Bilchik AJArch Surg 2007[Jun]; 142 (6): 526-31; discussion 531-2HYPOTHESIS: Multimodal treatment consisting of repeated hepatectomy and adjuvant systemic chemotherapy for liver-confined recurrence of colorectal cancer can yield long-term survival comparable with that associated with primary hepatectomy. DESIGN: Retrospective analysis. SETTING: A prospective database at a tertiary referral cancer center. PATIENTS: Review of 274 consecutive liver resections identified 64 patients who underwent resection of hepatic colorectal metastases without ablation followed by adjuvant irinotecan hydrochloride- or oxaliplatin-based systemic chemotherapy. MAIN OUTCOME MEASURES: Median and 5-year overall and disease-free survival after primary and repeated hepatectomy. RESULTS: At median follow-up of 40 months, median and 5-year overall survival after hepatectomy were 60 months and 53%, respectively; median and 5-year disease-free survival were 33 months and 25%, respectively. Multivariate analysis showed that less than 1 year between colectomy and liver resection (P = .001), more than 3 metastases (P = .001), no repeated hepatectomy (P = .01), and lymph node-positive primary colon cancer (P = .02) were independently predictive of worse survival. Of 28 patients (44%) with liver-confined recurrence, 19 (30%) underwent repeated hepatectomy; at median follow-up of 38 months, median and 5-year overall survival after repeated hepatectomy were 48 months and 44%, respectively. No risk factors were identified in multivariate analysis. In patients with recurrence, median and 5-year overall survival measured from primary hepatectomy were 70 months and 73%, respectively, with repeated hepatectomy vs 43 months and 43%, respectively, without repeated hepatectomy (P = .03). CONCLUSION: Multimodal treatment of recurrent colorectal cancer confined to the liver should begin with consideration of repeated hepatectomy.|*Hepatectomy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antineoplastic Agents/*administration & dosage[MESH]|Camptothecin/administration & dosage/*analogs & derivatives[MESH]|Colorectal Neoplasms/mortality/*pathology/therapy[MESH]|Combined Modality Therapy[MESH]|Female[MESH]|Humans[MESH]|Irinotecan[MESH]|Liver Neoplasms/mortality/secondary/*therapy[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local/mortality/secondary/*therapy[MESH]|Organoplatinum Compounds/*administration & dosage[MESH]|Oxaliplatin[MESH]|Reoperation[MESH]|Retrospective Studies[MESH]|Risk Factors[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH] |
