Annals of Surgical Oncology

, Volume 19, Issue 1, pp 139–144 | Cite as

Recurrence Following Hepatectomy for Metastatic Colorectal Cancer: Development of a Model that Predicts Patterns of Recurrence and Survival

  • Charles R. St. Hill
  • Ryaz B. Chagpar
  • Glenda G. Callender
  • Russell E. Brown
  • Juliana E. Gilbert
  • Robert C. G. MartinII
  • Kelly M. McMasters
  • Charles R. Scoggins
Colorectal Cancer



While several prognostic models have been developed to predict survival of patients who undergo hepatectomy for metastatic colorectal cancer (mCRC), few data exist to predict survival after recurrence. We sought to develop a model that predicts survival for patients who have developed recurrence following hepatectomy for mCRC.


A retrospective analysis was performed on data from consecutive patients that underwent hepatectomy for mCRC. Clinicopathologic data, recurrence patterns, and outcomes were analyzed. Kaplan–Meier survival analysis and univariate and multivariate analyses were performed. An integer-based model was created to predict the patterns of recurrence and survival after recurrence.


This analysis included 280 patients with a median follow-up of 50.1 months. Of these, 53% underwent major hepatectomy and 87% had negative margins. Recurrent disease developed in 63% of patients. After hepatectomy, factors associated with short disease-free interval (DFI) and overall survival (OS) included CEA > 200 ng/ml (P < 0.0005), >1 metastasis (P < 0.0005), and a high Fong score (P < 0.0005). After recurrence, the pattern of recurrence was a strong predictor of OS (P < 0.0005). Independent predictors of the pattern of recurrence on multivariate analysis include CEA > 200 ng/ml, tumor size >5 cm, and >1 liver metastasis. A simple predictive scoring system was developed from the beta coefficients of this analysis that correlated with recurrence pattern (P < 0.0005).


After hepatectomy, survival of patients with recurrent mCRC is strongly predicted by the patterns of recurrence, and the recurrence pattern can be predicted with a simple model. This can also be extended to create a scoring system that estimates expected survival.


Overall Survival Liver Metastasis Hepatic Resection Metastatic Colorectal Cancer Major Hepatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, et al. Repeat hepatectomy for colorectal liver metastases. Ann Surg. 1997;225:51–60; discussion 60–2.PubMedCrossRefGoogle Scholar
  2. 2.
    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57; discussion 657–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990 s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Scoggins CR, Campbell ML, Landry CS, Slomiany BA, Woodall CE, McMasters KM, et al. Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases. Ann Surg Oncol. 2009;16:35–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Bilchik AJ, Poston G, Curley SA, Strasberg S, Saltz L, Adam R, et al. Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol. 2005;23:9073–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18; discussion 318–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004; 239:818–25; discussion 825–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Schiffman SC, Bower M, Brown RE, Martin RC, McMasters KM, Scoggins CR. Hepatectomy is superior to thermal ablation for patients with a solitary colorectal liver metastasis. J Gastrointest Surg. 2010;14:1881–6; discussion 1886–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K. Repeat liver resection for recurrent colorectal liver metastases. Am J Surg. 1999;178:275–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Marudanayagam R, Ramkumar K, Shanmugam V, Langman G, Rajesh P, Coldham C, et al. Long-term outcome after sequential resections of liver and lung metastases from colorectal carcinoma. HPB (Oxford). 2009;11:671–6.CrossRefGoogle Scholar
  11. 11.
    D’Angelica M, Kornprat P, Gonen M, Dematteo RP, Fong Y, Blumgart LH, et al. Effect on outcome of recurrence patterns after hepatectomy for colorectal metastases. Ann Surg Oncol. 2011;18:1096–103.PubMedCrossRefGoogle Scholar
  12. 12.
    Tsai MS, Su YH, Ho MC, Liang JT, Chen TP, Lai HS, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol. 2007;14:786–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Tan MC, Castaldo ET, Gao F, Chari RS, Linehan DC, Wright JK, et al. A prognostic system applicable to patients with resectable liver metastasis from colorectal carcinoma staged by positron emission tomography with [18F]fluoro-2-deoxy-D-glucose: role of primary tumor variables. J Am Coll Surg. 2008;206:857–68; discussion 868–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.PubMedCrossRefGoogle Scholar
  16. 16.
    Nakajima Y, Nagao M, Ko S, Kanehiro H, Hisanaga M, Aomatsu Y, et al. Clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer. Hepatogastroenterology. 2001;48:1680–4.PubMedGoogle Scholar
  17. 17.
    Holm A, Bradley E, Aldrete JS. Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrence. Ann Surg. 1989;209:428–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Yamada H, Kondo S, Okushiba S, Morikawa T, Katoh H. Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases. World J Surg. 2001;25:1129–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Inoue M, Ohta M, Iuchi K, Matsumura A, Ideguchi K, Yasumitsu T, et al. Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2004;78:238–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Morise Z, Sugioka A, Fujita J, Hoshimoto S, Kato T, Hasumi A, et al. Does repeated surgery improve the prognosis of colorectal liver metastases? J Gastrointest Surg. 2006;10:6–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Poston GJ, Figueras J, Giuliante F, Nuzzo G, Sobrero AF, Gigot JF, et al. Urgent need for a new staging system in advanced colorectal cancer. J Clin Oncol. 2008;26:4828–33.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Charles R. St. Hill
    • 1
  • Ryaz B. Chagpar
    • 2
  • Glenda G. Callender
    • 1
  • Russell E. Brown
    • 1
  • Juliana E. Gilbert
    • 1
  • Robert C. G. MartinII
    • 1
  • Kelly M. McMasters
    • 1
  • Charles R. Scoggins
    • 1
  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of LouisvilleLouisvilleUSA
  2. 2.Department of SurgeryUniversity of Western OntarioLondonCanada

Personalised recommendations