Recurrence after partial hepatectomy for metastatic colorectal cancer: Potentially curative role of salvage repeat resection Journal Article

   

Authors:	Butte, J. M.; Gönen, M.; Allen, P. J.; Peter Kingham, T; Sofocleous, C. T.; DeMatteo, R. P.; Fong, Y.; Kemeny, N. E.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title:	Recurrence after partial hepatectomy for metastatic colorectal cancer: Potentially curative role of salvage repeat resection
Abstract:	Purpose: Patients with recurrence after complete resection of colorectal liver metastases (CLM) are considered for repeat resection as a potential salvage therapy (PST). However, outcomes for this approach are not well defined. We sought to analyze the natural history of recurrence and PST in a large cohort of patients with long-term follow-up. Methods: Recurrence patterns, treatments, and outcomes in consecutive patients undergoing resection for colorectal liver metastases were analyzed retrospectively. PST was defined as repeat resection of all recurrent disease and effective salvage therapy (EST) as free of disease for 36 months after last PST. Factors associated with PST, EST, and outcomes were analyzed. Results: Of 952 patients who underwent resection, 594 (62 %) experienced recurrence (median interval = 13 months). Initial recurrences involved liver (n = 157,26 %), lung (n = 167,28 %), multiple sites (n = 171,29 %), and other single sites (n = 99,17 %). PST was performed in 160 (27 %) of 594, most commonly with a single site of recurrence (n = 149). Young age (p = 0.01), negative initial resection margin (p = 0.003), initial tumor size <5 cm (p = 0.006), and recurrence pattern (p < 0.001) were independently associated with PST. Thirty-six patients experienced EST (25 % of PSTs). Overall median survival was 61 and 43 months in those with recurrence. Median survival of patients undergoing PST was 87 months compared to 34 months for those who did not. Conclusions: Recurrence is common after CLM resection, but 27 % of patients were able to undergo PST. Approximately one-quarter of these experienced EST and may be cured. PST is associated with long-term survival and possible cure, and therefore active surveillance after CLM resection is justified. © 2015, Society of Surgical Oncology.
Keywords:	adult; aged; major clinical study; overall survival; cancer recurrence; salvage therapy; recurrence risk; tumor volume; reoperation; partial hepatectomy; metastatic colorectal cancer; colorectal liver metastasis; human; male; female; article
Journal Title:	Annals of Surgical Oncology
Volume:	22
Issue:	8
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2015-08-01
Start Page:	2761
End Page:	2771
Language:	English
DOI:	10.1245/s10434-015-4370-1
PROVIDER:	scopus
PUBMED:	25572686
PMCID:	PMC4780326
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84938294064&partnerID=40&md5=f87175d73fe6965999bfedb5e630ac7a
Notes:	Export Date: 2 September 2015 -- Source: Scopus

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