BACKGROUND: Rapid remnant liver recurrence in patients with synchronous colorectal liver metastases (CRLM) is occasionally experienced after simultaneous colorectal and liver resection. We evaluated the tumor progression during interval periods to determine whether delayed hepatic resection detects occult metastases. METHODS: One hundred thirty-seven patients underwent hepatectomy for synchronous CRLM. Up to 2003, 116 patients underwent simultaneous colorectal and hepatic resection. From 2004 onward, we identified 21 patients undergoing delayed hepatectomy for synchronous CRLM. The tumor progression during interval was determined by a dynamic computed tomography scan. RESULTS: Median/mean interval between the two evaluations prior to the first and second surgery was 2/2.4 months. The median/mean number of metastases detected at each evaluation was 2/3.3 and 3/4.6, respectively. Nine of the 21 (43%) patients had new detectable metastatic lesions after reevaluation. For 11 of the 21 patients, it was necessary to reconsider planned surgical procedure which was determined prior to colorectal surgery. Hepatic disease-free survival was significantly different between patients undergoing delayed and simultaneous hepatectomy. Multivariate analysis showed that the delayed hepatectomy was a significant independent prognostic factor in hepatic disease-free survival. CONCLUSION: Tumor progression was recognized and occult metastases were detected after the interval reevaluation. Delayed hepatectomy may be a useful approach to reduce rapid remnant liver recurrence in synchronous CRLM.
BACKGROUND: Rapid remnant liver recurrence in patients with synchronous colorectal liver metastases (CRLM) is occasionally experienced after simultaneous colorectal and liver resection. We evaluated the tumor progression during interval periods to determine whether delayed hepatic resection detects occult metastases. METHODS: One hundred thirty-seven patients underwent hepatectomy for synchronous CRLM. Up to 2003, 116 patients underwent simultaneous colorectal and hepatic resection. From 2004 onward, we identified 21 patients undergoing delayed hepatectomy for synchronous CRLM. The tumor progression during interval was determined by a dynamic computed tomography scan. RESULTS: Median/mean interval between the two evaluations prior to the first and second surgery was 2/2.4 months. The median/mean number of metastases detected at each evaluation was 2/3.3 and 3/4.6, respectively. Nine of the 21 (43%) patients had new detectable metastatic lesions after reevaluation. For 11 of the 21 patients, it was necessary to reconsider planned surgical procedure which was determined prior to colorectal surgery. Hepatic disease-free survival was significantly different between patients undergoing delayed and simultaneous hepatectomy. Multivariate analysis showed that the delayed hepatectomy was a significant independent prognostic factor in hepatic disease-free survival. CONCLUSION:Tumor progression was recognized and occult metastases were detected after the interval reevaluation. Delayed hepatectomy may be a useful approach to reduce rapid remnant liver recurrence in synchronous CRLM.
Authors: Y Fong; A M Cohen; J G Fortner; W E Enker; A D Turnbull; D G Coit; A M Marrero; M Prasad; L H Blumgart; M F Brennan Journal: J Clin Oncol Date: 1997-03 Impact factor: 44.544
Authors: S Ambiru; M Miyazaki; T Isono; H Ito; K Nakagawa; H Shimizu; K Kusashio; S Furuya; N Nakajima Journal: Dis Colon Rectum Date: 1999-05 Impact factor: 4.585
Authors: S Iwatsuki; I Dvorchik; J R Madariaga; J W Marsh; F Dodson; A C Bonham; D A Geller; T J Gayowski; J J Fung; T E Starzl Journal: J Am Coll Surg Date: 1999-09 Impact factor: 6.113
Authors: René Adam; Gerard Pascal; Denis Castaing; Daniel Azoulay; Valerie Delvart; Bernard Paule; Francis Levi; Henri Bismuth Journal: Ann Surg Date: 2004-12 Impact factor: 12.969
Authors: H M C Shantha Kumara; David Gaita; Hiromichi Miyagaki; Xiaohong Yan; Sonali Ac Hearth; Linda Njoh; Vesna Cekic; Richard L Whelan Journal: World J Gastrointest Oncol Date: 2016-08-15
Authors: H M C Shantha Kumara; Erica Pettke; Abhinit Shah; Xiaohong Yan; Vesna Cekic; Melissa Alvarez Downing; Nipa Dilip Gandhi; Richard L Whelan Journal: World J Surg Oncol Date: 2018-07-07 Impact factor: 2.754
Authors: Bong-Hyeon Kye; Suk-Hwan Lee; Woon Kyung Jeong; Chang Sik Yu; In Ja Park; Hyeong Rok Kim; Jin Kim; In Kyu Lee; Ki-Jea Park; Hong-Jo Choi; Ho Young Kim; Jeong-Heum Baek; Yoon-Suk Lee Journal: Ann Surg Treat Res Date: 2019-10-01 Impact factor: 1.859