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Erschienen in: World Journal of Surgery 4/2013

01.04.2013

Good Candidates for a Third Liver Resection of Colorectal Metastasis

verfasst von: Shintaro Yamazaki, Tadatoshi Takayama, Shunji Okada, Atsuko Iwama, Yutaka Midorikawa, Masamichi Moriguchi, Hisashi Nakayama, Tokio Higaki, Masahiko Sugutani

Erschienen in: World Journal of Surgery | Ausgabe 4/2013

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Abstract

Background

Having three liver resections for colorectal metastases has long been considered to be associated with a high risk of postoperative complications. The present study was designed to assess the feasibility and survival benefits of three liver resections.

Methods

Between 2004 and 2011, data for 273 consecutive patients with colorectal metastases were analyzed. The patient characteristics, tumor status, operation-related variables, degree of liver steatosis, and short- and long-term outcomes were compared according to the number of liver resections.

Results

The history of preoperative chemotherapy was higher for patients who had had three liver resections as compared with other resections: i.e., one resection 41.0 %, versus two resections 56.8 %, versus three resections 81.8 %; p = 0.04. Patients receiving three liver resections had a high rate of liver steatosis (17.9 vs. 32.4 vs. 59.1 %; p = 0.03). The median operative time for three resections was significantly longer than for the other resections (359 min [range: 115–579 min] vs. 395 min [range: 178–740 min], vs. 482 min [range: 195–616 min]; p = 0.04). However, the complication rate and the postoperative hospital stay did not differ among the three groups. The 1-, 3- and 5-year survival rates did not differ significantly among the three groups (83.3, 57.5, and 44.6 % for one resection vs. 92.3, 52.1, and 35.7 % for two resections vs. 93.3, 49.0, and 34.1 % for three resections). Patients who had <5 tumors at a third liver resection and a recurrence interval of ≥500 days from the second resection were good candidates for three resections.

Conclusions

Undergoing three resections of colorectal metastasis is feasible and provides a similar survival benefit as one or two resections, without increasing morbidity or mortality.
Literatur
1.
Zurück zum Zitat Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRef Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRef
2.
Zurück zum Zitat Ribero D, Wang H, Donadon M et al (2007) Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 110:2761–2767PubMedCrossRef Ribero D, Wang H, Donadon M et al (2007) Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 110:2761–2767PubMedCrossRef
3.
Zurück zum Zitat Chun YS, Vauthey JN, Boonsirikamchai P et al (2009) Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA 302:2338–2344PubMedCrossRef Chun YS, Vauthey JN, Boonsirikamchai P et al (2009) Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA 302:2338–2344PubMedCrossRef
4.
Zurück zum Zitat Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731PubMedCrossRef Ekberg H, Tranberg KG, Andersson R et al (1986) Determinants of survival in liver resection for colorectal secondaries. Br J Surg 73:727–731PubMedCrossRef
5.
Zurück zum Zitat Bozzetti F, Doci R, Bignami P et al (1987) Patterns of failure following surgical resection of colorectal cancer liver metastases. Rationale for a multimodal approach. Ann Surg 205:264–270PubMedCrossRef Bozzetti F, Doci R, Bignami P et al (1987) Patterns of failure following surgical resection of colorectal cancer liver metastases. Rationale for a multimodal approach. Ann Surg 205:264–270PubMedCrossRef
6.
Zurück zum Zitat Stone MD, Cady B, Jenkins RL et al (1990) Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg 125:718–722PubMedCrossRef Stone MD, Cady B, Jenkins RL et al (1990) Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg 125:718–722PubMedCrossRef
7.
Zurück zum Zitat Petrowsky H, Gonen M, Jarnagin W et al (2002) Second liver resection are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235:863–871PubMedCrossRef Petrowsky H, Gonen M, Jarnagin W et al (2002) Second liver resection are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235:863–871PubMedCrossRef
8.
Zurück zum Zitat Nishio H, Hamady ZZ, Malik HZ et al (2007) Outcome following repeat liver resection for colorectal liver metastases. Eur J Surg Oncol 33:729–734PubMedCrossRef Nishio H, Hamady ZZ, Malik HZ et al (2007) Outcome following repeat liver resection for colorectal liver metastases. Eur J Surg Oncol 33:729–734PubMedCrossRef
9.
Zurück zum Zitat Sa Cunha A, Laurent C, Rault A et al (2007) A second liver resection due to recurrent colorectal liver metastases. Arch Surg 142:1144–1149PubMedCrossRef Sa Cunha A, Laurent C, Rault A et al (2007) A second liver resection due to recurrent colorectal liver metastases. Arch Surg 142:1144–1149PubMedCrossRef
10.
Zurück zum Zitat Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321PubMedCrossRef Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–321PubMedCrossRef
11.
Zurück zum Zitat Nordlinger B, Guiguet M, Vaillant JC et al (1996) Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Cancer 77:1254–1262PubMedCrossRef Nordlinger B, Guiguet M, Vaillant JC et al (1996) Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Cancer 77:1254–1262PubMedCrossRef
12.
Zurück zum Zitat Gomez D, Malik HZ, Bonney GK et al (2007) Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastases. Br J Surg 94:1395–1402PubMedCrossRef Gomez D, Malik HZ, Bonney GK et al (2007) Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastases. Br J Surg 94:1395–1402PubMedCrossRef
13.
Zurück zum Zitat Yamamoto J, Kosuge T, Shimada K et al (1999) Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 178:275–281PubMedCrossRef Yamamoto J, Kosuge T, Shimada K et al (1999) Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 178:275–281PubMedCrossRef
14.
Zurück zum Zitat Adam R, Pascal G, Azoulay D et al (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238:871–883PubMedCrossRef Adam R, Pascal G, Azoulay D et al (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238:871–883PubMedCrossRef
15.
Zurück zum Zitat Nagakura S, Shirai Y, Suda T et al (2002) Multiple repeat resections of intra- and extrahepatic recurrences in patients undergoing initial hepatectomy for colorectal carcinoma metastases. World J Surg 26:141–147. doi:10.1007/s00268-001-0196-z PubMedCrossRef Nagakura S, Shirai Y, Suda T et al (2002) Multiple repeat resections of intra- and extrahepatic recurrences in patients undergoing initial hepatectomy for colorectal carcinoma metastases. World J Surg 26:141–147. doi:10.​1007/​s00268-001-0196-z PubMedCrossRef
16.
Zurück zum Zitat Kooby DA, Fong Y, Suriawinata A et al (2003) Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg 7:1034–1044PubMedCrossRef Kooby DA, Fong Y, Suriawinata A et al (2003) Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg 7:1034–1044PubMedCrossRef
17.
Zurück zum Zitat Karoui M, Penna C, Amin-Hashem M et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243:1–7PubMedCrossRef Karoui M, Penna C, Amin-Hashem M et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243:1–7PubMedCrossRef
18.
Zurück zum Zitat Konopke R, Kersting S, Bunk A et al (2009) Colorectal liver metastases surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection. Int J Colorectal Dis 24:687–697PubMedCrossRef Konopke R, Kersting S, Bunk A et al (2009) Colorectal liver metastases surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection. Int J Colorectal Dis 24:687–697PubMedCrossRef
19.
Zurück zum Zitat Makuuchi M, Kosuge T, Takayama T et al (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304PubMedCrossRef Makuuchi M, Kosuge T, Takayama T et al (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304PubMedCrossRef
20.
Zurück zum Zitat Makuuchi M, Thai BL, Takayasu K et al (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527PubMed Makuuchi M, Thai BL, Takayasu K et al (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 107:521–527PubMed
21.
Zurück zum Zitat Imamura H, Takayama T, Sugawara Y et al (2002) Pringle’s maneuver in living donors. Lancet 360:2049–2050PubMedCrossRef Imamura H, Takayama T, Sugawara Y et al (2002) Pringle’s maneuver in living donors. Lancet 360:2049–2050PubMedCrossRef
22.
Zurück zum Zitat Kokudo N, Bandai Y, Imanishi H et al (1996) Management of new hepatic nodules detected by intraoperative ultrasonography during hepatic resection for hepatocellular carcinoma. Surgery 119:634–640PubMedCrossRef Kokudo N, Bandai Y, Imanishi H et al (1996) Management of new hepatic nodules detected by intraoperative ultrasonography during hepatic resection for hepatocellular carcinoma. Surgery 119:634–640PubMedCrossRef
23.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef
24.
Zurück zum Zitat McCormack L, Petrowsky H, Jochum W et al (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930PubMedCrossRef McCormack L, Petrowsky H, Jochum W et al (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930PubMedCrossRef
25.
Zurück zum Zitat Pathak S, Tang JM, Terlizzo M et al (2010) Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases. Eur J Surg Oncol 36:52–57PubMedCrossRef Pathak S, Tang JM, Terlizzo M et al (2010) Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases. Eur J Surg Oncol 36:52–57PubMedCrossRef
26.
Zurück zum Zitat Elias D, Lasser PH, Hoang JM et al (1993) Repeat hepatectomy for cancer. Br J Surg 80:1557–1562PubMedCrossRef Elias D, Lasser PH, Hoang JM et al (1993) Repeat hepatectomy for cancer. Br J Surg 80:1557–1562PubMedCrossRef
27.
Zurück zum Zitat Muratore A, Polastri R, Bouzari H et al (2001) Repeat hepatectomy for colorectal liver metastases: a worthwhile operation? J Surg Oncol 76:127–132PubMedCrossRef Muratore A, Polastri R, Bouzari H et al (2001) Repeat hepatectomy for colorectal liver metastases: a worthwhile operation? J Surg Oncol 76:127–132PubMedCrossRef
28.
Zurück zum Zitat Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–499PubMedCrossRef Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–499PubMedCrossRef
29.
Zurück zum Zitat Pessaux P, Lermite E, Brehant O et al (2006) Repeat hepatectomy for recurrent colorectal liver metastases. J Surg Oncol 93:1–7PubMedCrossRef Pessaux P, Lermite E, Brehant O et al (2006) Repeat hepatectomy for recurrent colorectal liver metastases. J Surg Oncol 93:1–7PubMedCrossRef
30.
31.
Zurück zum Zitat Carpizo DR, D’Angelica M (2009) Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease. Ann Surg Oncol 16:2411–2421PubMedCrossRef Carpizo DR, D’Angelica M (2009) Liver resection for metastatic colorectal cancer in the presence of extrahepatic disease. Ann Surg Oncol 16:2411–2421PubMedCrossRef
32.
Zurück zum Zitat Imamura H, Seyama Y, Kokudo N et al (2004) Single and multiple resections of multiple hepatic metastases of colorectal origin. Surgery 135:508–517PubMedCrossRef Imamura H, Seyama Y, Kokudo N et al (2004) Single and multiple resections of multiple hepatic metastases of colorectal origin. Surgery 135:508–517PubMedCrossRef
33.
Zurück zum Zitat Malik HZ, Gomez D, Wong V et al (2007) Predictors of early disease recurrence following hepatic resection for colorectal cancer metastases. Eur J Surg Oncol 33:1003–1009PubMedCrossRef Malik HZ, Gomez D, Wong V et al (2007) Predictors of early disease recurrence following hepatic resection for colorectal cancer metastases. Eur J Surg Oncol 33:1003–1009PubMedCrossRef
34.
Zurück zum Zitat Kornprat P, Jarnagin WR, Gonen M et al (2007) Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol 14:1151–1160PubMedCrossRef Kornprat P, Jarnagin WR, Gonen M et al (2007) Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol 14:1151–1160PubMedCrossRef
35.
Zurück zum Zitat Tanaka K, Shimada H, Ueda M et al (2008) Role of hepatectomy in treating multiple bilobar colorectal cancer metastases. Surgery 143:259–270PubMedCrossRef Tanaka K, Shimada H, Ueda M et al (2008) Role of hepatectomy in treating multiple bilobar colorectal cancer metastases. Surgery 143:259–270PubMedCrossRef
36.
Zurück zum Zitat D’Angelica M, Kornprat P, Gonen M et al (2011) Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases. Ann Surg Oncol 18:1096–1103PubMedCrossRef D’Angelica M, Kornprat P, Gonen M et al (2011) Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases. Ann Surg Oncol 18:1096–1103PubMedCrossRef
Metadaten
Titel
Good Candidates for a Third Liver Resection of Colorectal Metastasis
verfasst von
Shintaro Yamazaki
Tadatoshi Takayama
Shunji Okada
Atsuko Iwama
Yutaka Midorikawa
Masamichi Moriguchi
Hisashi Nakayama
Tokio Higaki
Masahiko Sugutani
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 4/2013
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1887-3

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