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08.02.2018 | Original Scientific Report

Aggressive and Multidisciplinary Local Approach to Iterative Recurrences of Colorectal Liver Metastases

verfasst von: Luca Viganò, Vittorio Pedicini, Tiziana Comito, Carlo Carnaghi, Guido Costa, Dario Poretti, Ciro Franzese, Nicola Personeni, Daniele Del Fabbro, Lorenza Rimassa, Marta Scorsetti, Armando Santoro, Luigi Solbiati, Guido Torzilli

Erschienen in: World Journal of Surgery | Ausgabe 8/2018

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Abstract

Background

Liver resection (LR) of colorectal metastases is associated with high recurrence risk. Aggressive local retreatment is advocated, but further recurrences may occur. Poor is known about presentation, treatment, and outcome of iterative recurrences.

Methods

A series of 323 consecutive patients undergoing first LR in the period 2004–2013 was reviewed. Patients with recurrence were included. Any local treatment (surgery, radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT)) was analyzed. If first recurrence (1st Rec) was treated, further recurrences and treatments were considered.

Results

Overall, 206 (63.8%) patients had 1st Rec; 105 (51.0%) were treated (72 surgery, 19 RFA, 14 SBRT). Among treated patients, 78.1% had 2nd Rec, 74.4% 3rd Rec, 72.2% 4th Rec. Liver involvement progressively decreased (from 81.6 to 30.8%), and pulmonary one increased (from 23.3 to 53.8%). The proportion of treated patients remained stable (1st Rec = 51%, 2nd Rec = 55%, 3rd Rec = 56.3%, 4th Rec = 69.2%): surgery and RFA decreased (from 35.4 to 23.1%; from 9.2 to 0%) and SBRT increased (from 6.8 to 46.2%). Overall, 105 patients received 205 treatments (133 operations in 80 patients). Surgery had the best local disease control: at 2 years 93.4% versus RFA 56.4% (p = 0.0008) and SBRT 74.0% (p = 0.051). In comparison with chemotherapy, recurrence treatment improved survival after 1st Rec (3-year survival 62.9 vs. 13.4%, p < 0.0001), 2nd Rec (61.3 vs. 22.5%, p < 0.0001), and 3rd Rec (2-year survival 88.9 vs. 30.8%, p = 0.005).

Conclusions

Aggressive local treatment of recurrent metastases may improve survival, even in the case of iterative recurrences and extrahepatic lesions. Surgery is the standard, but a multidisciplinary approach should be adopted to enlarge the pool of treatable patients.

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Titel: Aggressive and Multidisciplinary Local Approach to Iterative Recurrences of Colorectal Liver Metastases
verfasst von: Luca Viganò
Vittorio Pedicini
Tiziana Comito
Carlo Carnaghi
Guido Costa
Dario Poretti
Ciro Franzese
Nicola Personeni
Daniele Del Fabbro
Lorenza Rimassa
Marta Scorsetti
Armando Santoro
Luigi Solbiati
Guido Torzilli
Publikationsdatum: 08.02.2018
Verlag: Springer International Publishing
Erschienen in: World Journal of Surgery / Ausgabe 8/2018
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4525-x

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