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International Journal of Clinical Oncology

Erschienen in:

04.04.2018 | Original Article

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

verfasst von: Katsunori Imai, Yo-ichi Yamashita, Yuji Miyamoto, Shigeki Nakagawa, Hirohisa Okabe, Daisuke Hashimoto, Akira Chikamoto, Hideo Baba

Erschienen in: International Journal of Clinical Oncology | Ausgabe 5/2018

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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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Titel: The predictors and oncological outcomes of repeat surgery for recurrence after hepatectomy for colorectal liver metastases
verfasst von: Katsunori Imai
Yo-ichi Yamashita
Yuji Miyamoto
Shigeki Nakagawa
Hirohisa Okabe
Daisuke Hashimoto
Akira Chikamoto
Hideo Baba
Publikationsdatum: 04.04.2018
Verlag: Springer Japan
Erschienen in: International Journal of Clinical Oncology / Ausgabe 5/2018
Print ISSN: 1341-9625
Elektronische ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-018-1273-8

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

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