Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: Results from an international multi-institutional analysis

Mechteld C. de Jong, Skye C. Mayo, Carlo Pulitano, Serena Lanella, Dario Ribero, Jennifer Strub, Catherine Hubert, Jean François Gigot, Richard D. Schulick, Michael A. Choti, Luca Aldrighetti, Gilles Mentha, Lorenzo Capussotti, Timothy M. Pawlik

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Abstract

Introduction: Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0%). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25. 5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.

Original languageEnglish (US)
Pages (from-to)2141-2151
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume13
Issue number12
DOIs
StatePublished - Dec 2009

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Neoplasm Metastasis
Liver
Survival
Colorectal Surgery
Morbidity
Mortality
Databases
Safety
Recurrence

Keywords

  • Colorectal cancer
  • Liver
  • Metastasis
  • Repeat
  • Resection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis : Results from an international multi-institutional analysis. / de Jong, Mechteld C.; Mayo, Skye C.; Pulitano, Carlo; Lanella, Serena; Ribero, Dario; Strub, Jennifer; Hubert, Catherine; Gigot, Jean François; Schulick, Richard D.; Choti, Michael A.; Aldrighetti, Luca; Mentha, Gilles; Capussotti, Lorenzo; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 13, No. 12, 12.2009, p. 2141-2151.

Research output: Contribution to journalArticle

de Jong, MC, Mayo, SC, Pulitano, C, Lanella, S, Ribero, D, Strub, J, Hubert, C, Gigot, JF, Schulick, RD, Choti, MA, Aldrighetti, L, Mentha, G, Capussotti, L & Pawlik, TM 2009, 'Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: Results from an international multi-institutional analysis', Journal of Gastrointestinal Surgery, vol. 13, no. 12, pp. 2141-2151. https://doi.org/10.1007/s11605-009-1050-0
de Jong, Mechteld C. ; Mayo, Skye C. ; Pulitano, Carlo ; Lanella, Serena ; Ribero, Dario ; Strub, Jennifer ; Hubert, Catherine ; Gigot, Jean François ; Schulick, Richard D. ; Choti, Michael A. ; Aldrighetti, Luca ; Mentha, Gilles ; Capussotti, Lorenzo ; Pawlik, Timothy M. / Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis : Results from an international multi-institutional analysis. In: Journal of Gastrointestinal Surgery. 2009 ; Vol. 13, No. 12. pp. 2141-2151.
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title = "Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: Results from an international multi-institutional analysis",
abstract = "Introduction: Although 5-year survival approaches 55{\%} following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4{\%}) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8{\%}) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0{\%}). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9{\%} versus second CIS, 21.1{\%} versus third/fourth CIS, 16.4{\%}; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1{\%} versus third/fourth CIS, 25. 5{\%}). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1{\%}, 32.6{\%}, and 23.8{\%} following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.",
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TY - JOUR

T1 - Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis

T2 - Results from an international multi-institutional analysis

AU - de Jong, Mechteld C.

AU - Mayo, Skye C.

AU - Pulitano, Carlo

AU - Lanella, Serena

AU - Ribero, Dario

AU - Strub, Jennifer

AU - Hubert, Catherine

AU - Gigot, Jean François

AU - Schulick, Richard D.

AU - Choti, Michael A.

AU - Aldrighetti, Luca

AU - Mentha, Gilles

AU - Capussotti, Lorenzo

AU - Pawlik, Timothy M.

PY - 2009/12

Y1 - 2009/12

N2 - Introduction: Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0%). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25. 5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.

AB - Introduction: Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients. Methods: Between 1982 and 2008, 1,706 patients who underwent CIS-defined as curative intent hepatic resection/radiofrequency ablation (RFA)-for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed. Results: Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n=219; 89.0%). A subset of patients underwent third (n=46) or fourth (n=9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21. 5 months; third → fourth, 11. 3 months; P=0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P=0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25. 5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P>0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01). Conclusion: Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.

KW - Colorectal cancer

KW - Liver

KW - Metastasis

KW - Repeat

KW - Resection

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