Cohort study of the survival benefit of resection for recurrent hepatic and/or pulmonary metastases after primary hepatectomy for colorectal metastases.

OBJECTIVE: To evaluate resection for hepatic and/or pulmonary recurrences in a cohort that underwent initial hepatectomy for colorectal liver metastases. SUMMARY BACKGROUND DATA: The survival benefit of repeated resections for hepatic and/or pulmonary recurrences after initial hepatectomy for colorectal liver metastases has remained unclear.
METHODS: Recurrence occurred in 166 of the 216 patients after the first hepatectomy. Repeated resections were performed in 98 patients. We investigated the pattern of recurrence, the proportion of patients who underwent repeated resection, and the surgical outcome.
RESULTS: Of the 166 patients with recurrence, 71 had isolated hepatic recurrence, 25 had isolated pulmonary recurrence, 13 had hepatic plus pulmonary recurrence, and 57 had recurrence in other organs. Repeated resections were conducted in 60 (85%) patients with isolated hepatic recurrence, 21 (84%) with isolated pulmonary recurrence, and 9 (69%) with both hepatic and pulmonary recurrence. The 5-year survival rates after repeated resection were 39%, 37%, and 20% for isolated hepatic recurrence, isolated pulmonary recurrence, and hepatic plus pulmonary recurrence, respectively. Multivariate analysis revealed that the following variables contributed to poor prognosis (hazard ratio [95% confidence interval]): number of recurrent tumors (1.20 [1.11-1.29]), maximum size of recurrent tumors (1.26 [1.02-1.48]), pulmonary recurrence (2.36 [1.41-3.20]), and hepatic plus pulmonary recurrence (4.01 [2.86-.17]).
CONCLUSIONS: Patients with pulmonary or hepatic plus pulmonary recurrence had poorer prognoses than those with isolated hepatic recurrence. Reresection is the only potentially curative treatment. Stricter indication criteria, especially regarding the number of tumor nodules, can lead to comparable long-term outcomes.