Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis

An international multi-institutional analysis of 1669 patients

Mechteld C. De Jong, Carlo Pulitano, Dario Ribero, Jennifer Strub, Gilles Mentha, Richard D. Schulick, Michael A. Choti, Luca Aldrighetti, Lorenzo Capussotti, Timothy M. Pawlik

Research output: Contribution to journalArticle

394 Citations (Scopus)

Abstract

OBJECTIVE(S):: To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis. BACKGROUND:: Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited. METHODS:: One thousand six hundred sixty-nine patients treated with surgery (resection ± radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS:: At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra-and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra-and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease. CONCLUSIONS:: While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra-plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.

Original languageEnglish (US)
Pages (from-to)440-447
Number of pages8
JournalAnnals of Surgery
Volume250
Issue number3
DOIs
StatePublished - Sep 2009

Fingerprint

Colorectal Surgery
Neoplasm Metastasis
Recurrence
Liver
Survival
Reoperation
Adjuvant Chemotherapy

ASJC Scopus subject areas

  • Surgery

Cite this

Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis : An international multi-institutional analysis of 1669 patients. / De Jong, Mechteld C.; Pulitano, Carlo; Ribero, Dario; Strub, Jennifer; Mentha, Gilles; Schulick, Richard D.; Choti, Michael A.; Aldrighetti, Luca; Capussotti, Lorenzo; Pawlik, Timothy M.

In: Annals of Surgery, Vol. 250, No. 3, 09.2009, p. 440-447.

Research output: Contribution to journalArticle

De Jong, MC, Pulitano, C, Ribero, D, Strub, J, Mentha, G, Schulick, RD, Choti, MA, Aldrighetti, L, Capussotti, L & Pawlik, TM 2009, 'Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: An international multi-institutional analysis of 1669 patients', Annals of Surgery, vol. 250, no. 3, pp. 440-447. https://doi.org/10.1097/SLA.0b013e3181b4539b
De Jong, Mechteld C. ; Pulitano, Carlo ; Ribero, Dario ; Strub, Jennifer ; Mentha, Gilles ; Schulick, Richard D. ; Choti, Michael A. ; Aldrighetti, Luca ; Capussotti, Lorenzo ; Pawlik, Timothy M. / Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis : An international multi-institutional analysis of 1669 patients. In: Annals of Surgery. 2009 ; Vol. 250, No. 3. pp. 440-447.
@article{40c8f5b9043a4e7890ef829a389a6dc5,
title = "Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: An international multi-institutional analysis of 1669 patients",
abstract = "OBJECTIVE(S):: To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis. BACKGROUND:: Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited. METHODS:: One thousand six hundred sixty-nine patients treated with surgery (resection ± radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS:: At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2{\%}), resection plus RFA (8.0{\%}), or RFA alone (1.8{\%}). While 5-year overall survival was 47.3{\%}, 947 (56.7{\%}) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2{\%}), extrahepatic only (35.8{\%}), intra-and extrahepatic (21.0{\%}). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra-and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease. CONCLUSIONS:: While 5-year survival following surgery for colorectal liver metastasis approaches 50{\%}, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra-plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.",
author = "{De Jong}, {Mechteld C.} and Carlo Pulitano and Dario Ribero and Jennifer Strub and Gilles Mentha and Schulick, {Richard D.} and Choti, {Michael A.} and Luca Aldrighetti and Lorenzo Capussotti and Pawlik, {Timothy M.}",
year = "2009",
month = "9",
doi = "10.1097/SLA.0b013e3181b4539b",
language = "English (US)",
volume = "250",
pages = "440--447",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis

T2 - An international multi-institutional analysis of 1669 patients

AU - De Jong, Mechteld C.

AU - Pulitano, Carlo

AU - Ribero, Dario

AU - Strub, Jennifer

AU - Mentha, Gilles

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Aldrighetti, Luca

AU - Capussotti, Lorenzo

AU - Pawlik, Timothy M.

PY - 2009/9

Y1 - 2009/9

N2 - OBJECTIVE(S):: To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis. BACKGROUND:: Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited. METHODS:: One thousand six hundred sixty-nine patients treated with surgery (resection ± radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS:: At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra-and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra-and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease. CONCLUSIONS:: While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra-plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.

AB - OBJECTIVE(S):: To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis. BACKGROUND:: Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited. METHODS:: One thousand six hundred sixty-nine patients treated with surgery (resection ± radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS:: At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra-and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra-and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease. CONCLUSIONS:: While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra-plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.

UR - http://www.scopus.com/inward/record.url?scp=70249110476&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70249110476&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181b4539b

DO - 10.1097/SLA.0b013e3181b4539b

M3 - Article

VL - 250

SP - 440

EP - 447

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -