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| Repeat hepatectomy for recurrent colorectal liver metastases: A comparative analysis of short- and long-term results |
| Paulo Figueiredo Costa a , Fabricio Ferreira Coelho b , ∗, Vagner Birk Jeismann b , Jaime Arthur Pirola Kruger c , Gilton Marques Fonseca b , Ivan Cecconello b , Paulo Herman b |
a Postgraduate Course in Digestive Surgery Brazilian College of Digestive Surgery (Colegio Brasileiro de Cirurgia Digestiva - CBCD), Sao Paulo, Brazil
b Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
c Instituto do Cancer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
∗ Corresponding author.
E-mail address: fabricio.coelho@hc.fm.usp.br (F.F. Coelho). |
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Abstract Background: Liver recurrence after resection of colorectal liver metastases (CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefits for patients with early recurrence have not been clarified. The aim of this study was to compare the short- and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early ( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared.
Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 2000 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy.
Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4 (3-6) vs. 3 (2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies (34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions re- sected (2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival ( P = 0.626) and disease-free survival ( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival ( P = 0.771) or disease-free survival (P = 0.350).
Conclusions: Repeat hepatectomy is feasible and safe, with similar short- and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.
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2022, Vol. 21 
