Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients

Luca Viganò, Lorenzo Capussotti, Réal Lapointe, Eduardo Barroso, Catherine Hubert, Felice Giuliante, Jan N M Ijzermans, Darius F Mirza, Dominique Elias, René Adam

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)

Abstract

PURPOSE: The aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management.

METHODS: Patients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection.

RESULTS: A total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3-4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028).

CONCLUSIONS: Early recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated.

Original languageEnglish
Pages (from-to)1276-1286
Number of pages11
JournalAnnals of Surgical Oncology
Volume21
Issue number4
Early online date18 Dec 2013
DOIs
Publication statusPublished - Apr 2014

Keywords

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols
  • Colorectal Neoplasms
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Hepatectomy
  • Humans
  • Liver Neoplasms
  • Male
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Survival Rate
  • Overall Survival
  • Liver Resection
  • Preoperative Chemotherapy
  • Early Recurrence
  • Late Recurrence

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