Surgical Resection for Recurrence After Two-Stage Hepatectomy for Colorectal Liver Metastases Is Feasible, Is Safe, and Improves Survival
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Recurrence rates are high for patients who have undergone two-stage hepatectomy (TSH) for bilateral colorectal liver metastases, and there is no established treatment approach for recurrent disease. This study aimed to determine the feasibility, safety, and prognostic impact of surgical resection for recurrence after TSH and the prognostic role of RAS mutation in this cohort.
The study included 137 patients intended to undergo TSH for bilateral colorectal metastases during 2003–2016. Clinicopathologic factors were compared using univariate and multivariate analyses.
One hundred eleven patients (81%) completed TSH. The median recurrence-free survival in these patients was 12 months. Of the 83 patients with subsequent recurrence, 31 (37%) underwent resection for recurrence, and 11 underwent multiple resections for recurrence. Forty-eight operations were performed for recurrence: 23 repeat hepatectomies, 14 pulmonary resections, 5 locoregional resections, and 6 concurrent resections in multiple organ sites. The median overall survival (OS) among patients with recurrence was 143 months for patients who underwent resection and 49 months for those who did not (P < 0.001). On multivariate analysis, resection for recurrence (hazard ratio [HR] 0.25; 95% CI 0.10–0.54, P < 0.001) was associated with better OS, whereas RAS mutation (HR 2.25; 95% CI 1.16–4.50, P = 0.016) and first recurrence in multiple sites (HR 2.28; 95% CI 1.17–4.37, P = 0.016) were independent predictors of worse overall survival.
In patients who have undergone TSH for bilateral colorectal liver metastases, recurrence is frequent and should be treated with resection whenever possible. Patients with wild-type RAS fare particularly well with resection for recurrence.
KeywordsColorectal neoplasms Hepatectomy Neoplasm metastases Recurrence
The authors thank Stephanie Deming (Department of Scientific Publications, MD Anderson Cancer Center) for copyediting the manuscript and Ruth J Haynes (Department of Surgical Oncology, MD Anderson Cancer Center) for secretarial assistance in the preparation of the manuscript.
Dr. Heather Lillemoe is supported by National Institutes of Health grant T32CA009599-29 and the MD Anderson Cancer Center support grant (P30 CA016672).
Statement of Author Contribution
- Substantial contributions to:
The conception or design of the work: HL, YK, ES, JNV
The acquisition, analysis, or interpretation of data for the work: HL, YK, GP, GK, YY, RM, YSH, CWT, TA, JNV
Drafting the work or revising it critically for important intellectual content: All authors
Final approval of the version to be published: All authors
Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors
- 12.Imai K, Benitez CC, Allard MA et al. Impact of surgical treatment for recurrence after 2-stage hepatectomy for colorectal liver metastases, on patient outcome. Ann Surg 2017. https://doi.org/10.1097/SLA.0000000000002472.
- 15.Chun YS, Passot G, Yamashita S et al. Deleterious effect of RAS and evolutionary high-risk TP53 double mutation in colorectal liver metastases. Ann Surg 2017. https://doi.org/10.1097/SLA.0000000000002450.