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04.04.2018 | Original Article | Ausgabe 5/2018

International Journal of Clinical Oncology 5/2018

The predictors and oncological outcomes of repeat surgery for recurrence after hepatectomy for colorectal liver metastases

Zeitschrift:
International Journal of Clinical Oncology > Ausgabe 5/2018
Autoren:
Katsunori Imai, Yo-ichi Yamashita, Yuji Miyamoto, Shigeki Nakagawa, Hirohisa Okabe, Daisuke Hashimoto, Akira Chikamoto, Hideo Baba
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10147-018-1273-8) contains supplementary material, which is available to authorized users.

Abstract

Purpose

Although recurrence after hepatectomy for colorectal liver metastases (CRLM) is common, the optimal treatment strategy remains unclear. The aims of this study were to clarify the impact of repeat surgery and identify the predictive factors for repeat surgery.

Methods

Among the 170 patients who underwent potentially curative surgery for CRLM, 113 developed recurrence. The predictive factors for the performance of repeat surgery were identified and a predictive model was constructed.

Results

The patterns of recurrence were as follows; single site [n = 100 (liver, n = 61; lung, n = 22; other, n = 17)], multiple site (n = 13). Repeat surgery was performed in 54 patients (47.8%) including re-hepatectomy (n = 25), radiofrequency ablation (n = 12), and resection of the extrahepatic recurrent disease (n = 17), and their overall survival (OS) was significantly better than that of those who could not (5-year OS 60.7 vs 19.5%, P < 0.0001). A multivariate analysis revealed that a primary N-negative status [relative risk (RR) 2.93, P = 0.017], indocyanine retention rate at 15 min ≤ 10% before hepatectomy (RR 2.49, P = 0.04), and carcinoembryonic antigen ≤ 5 ng/mL before hepatectomy (RR 2.96, P = 0.017) independently predicted the performance of repeat surgery. For patients who did not present any factors, the probability of repeat surgery was 19.6%. The addition of each subsequent factor increased the probability to 41.9, 67.8, and 84.0% (for 1, 2, and 3 factors, respectively).

Conclusions

Repeat surgery for not only intrahepatic but also extrahepatic recurrence is crucial for prolonging the survival of CRLM patients. The proposed model may help to predict the possibility of repeat surgery and provide optimal individualized treatment.

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Zusatzmaterial
Supplementary material 1 (DOCX 28 kb)
10147_2018_1273_MOESM1_ESM.docx
Literatur
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