J Hallet1,2,3, A Sa Cunha4, R Adam4, D Goéré5, P Bachellier6, D Azoulay7, A Ayav8, E Grégoire9, F Navarro10, P Pessaux1,2,11. 1. Institut Hospitalo-Universitaire, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France. 2. Institut de Recherche sur les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France. 3. Division of General Surgery, Sunnybrook Health Sciences Center - Odette Cancer Center, Toronto, Ontario, Canada. 4. Department of Surgery, Hôpital Paul Brousse, Villejuif, France. 5. Department of Surgery, Institut Gustave Roussy, Villejuif, France. 6. Department of Surgery, Hôpital Hautepierre, Strasbourg, France. 7. Department of Surgery, Hôpital Henri Mondor, Créteil, France. 8. Department of Surgery, Hôpital de Brabois, Centre Régional Hospitalier Universitaire de Nancy, Nancy, France. 9. Department of Surgery, Hôpital de la Timone, Marseilles, France. 10. Department of Surgery, Université de Montpellier, Hôpital Saint-Eloi, Montpellier, France. 11. General Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France.
Abstract
BACKGROUND: Data on recurrence patterns following hepatectomy for colorectal liver metastases (CRLMs) and their impact on long-term outcomes are limited in the setting of modern multimodal management. This study sought to characterize the patterns of, factors associated with, and survival impact of recurrence following initial hepatectomy for CRLMs. METHODS: A retrospective cohort study of patients undergoing initial hepatectomy for CRLMs at 39 institutions (2006-2013) was conducted. Kaplan-Meier methods were used for survival analyses. Overall survival landmark analysis at 12 months after hepatectomy was performed to compare groups based on recurrence. Multivariable Cox and regression models were used to determine factors associated with recurrence. RESULTS: Among 2320 patients, tumours recurred in 47·4 per cent at median of 10·1 (range 0-88) months; 89·1 per cent of recurrences developed within 3 years. Recurrence was intrahepatic in 46·2 per cent, extrahepatic in 31·8 per cent and combined intra/extrahepatic in 22·0 per cent. The 5-year overall survival rate decreased from 74·3 (95 per cent c.i. 72·2 to 76·4) per cent without recurrence to 57·5 (55·0 to 60·0) per cent with recurrence (adjusted hazard ratio (HR) 3·08, 95 per cent c.i. 2·31 to 4·09). After adjusting for clinicopathological variables, prehepatectomy factors associated with increased risk of recurrence were node-positive primary tumour (HR 1·27, 1·09 to 1·49), more than three liver metastases (HR 1·27, 1·06 to 1·52) and largest metastasis greater than 4 cm (HR 1·19; 1·01 to 1·43). CONCLUSION: Recurrence after CRLM resection remains common. Although overall survival is inferior with recurrence, excellent survival rates can still be achieved.
BACKGROUND: Data on recurrence patterns following hepatectomy for colorectal liver metastases (CRLMs) and their impact on long-term outcomes are limited in the setting of modern multimodal management. This study sought to characterize the patterns of, factors associated with, and survival impact of recurrence following initial hepatectomy for CRLMs. METHODS: A retrospective cohort study of patients undergoing initial hepatectomy for CRLMs at 39 institutions (2006-2013) was conducted. Kaplan-Meier methods were used for survival analyses. Overall survival landmark analysis at 12 months after hepatectomy was performed to compare groups based on recurrence. Multivariable Cox and regression models were used to determine factors associated with recurrence. RESULTS: Among 2320 patients, tumours recurred in 47·4 per cent at median of 10·1 (range 0-88) months; 89·1 per cent of recurrences developed within 3 years. Recurrence was intrahepatic in 46·2 per cent, extrahepatic in 31·8 per cent and combined intra/extrahepatic in 22·0 per cent. The 5-year overall survival rate decreased from 74·3 (95 per cent c.i. 72·2 to 76·4) per cent without recurrence to 57·5 (55·0 to 60·0) per cent with recurrence (adjusted hazard ratio (HR) 3·08, 95 per cent c.i. 2·31 to 4·09). After adjusting for clinicopathological variables, prehepatectomy factors associated with increased risk of recurrence were node-positive primary tumour (HR 1·27, 1·09 to 1·49), more than three liver metastases (HR 1·27, 1·06 to 1·52) and largest metastasis greater than 4 cm (HR 1·19; 1·01 to 1·43). CONCLUSION: Recurrence after CRLM resection remains common. Although overall survival is inferior with recurrence, excellent survival rates can still be achieved.
Authors: Julie Hallet; Antonio Sa Cunha; Daniel Cherqui; Brice Gayet; Diane Goéré; Philippe Bachellier; Alexis Laurent; David Fuks; Francis Navarro; Patrick Pessaux Journal: World J Surg Date: 2017-12 Impact factor: 3.352
Authors: Francesco Esposito; Chetana Lim; Antonio Sa Cunha; Patrick Pessaux; Francis Navarro; Daniel Azoulay Journal: World J Surg Date: 2018-12 Impact factor: 3.352
Authors: Dayna P Y Sim; Brian K P Goh; Ser-Yee Lee; Chung-Yip Chan; Iain B H Tan; Peng-Chung Cheow; Premaraj Jeyaraj; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung Journal: World J Surg Date: 2018-04 Impact factor: 3.352
Authors: Yoshikuni Kawaguchi; Heather A Lillemoe; Elena Panettieri; Yun Shin Chun; Ching-Wei D Tzeng; Thomas A Aloia; Scott Kopetz; Jean-Nicolas Vauthey Journal: J Am Coll Surg Date: 2019-05-02 Impact factor: 6.113
Authors: S Bennett; K Søreide; S Gholami; P Pessaux; C Teh; E Segelov; H Kennecke; H Prenen; S Myrehaug; D Callegaro; J Hallet Journal: Curr Oncol Date: 2020-10-01 Impact factor: 3.677
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Ding Ding; Ammar A Javed; Richard A Burkhart; Jun Yu; Inne H Borel Rinkes; I Quintus Molenaar; John L Cameron; Elliot K Fishman; Ralph H Hruban; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Oncol Date: 2018-06-14 Impact factor: 5.344