Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival.

Abstract

PURPOSE:

Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60% of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a consecutive series of patients with SMR.

METHODS:

From 01/2001 to 11/2011, 104 out of 178 consecutive patients with R0-resection of CRC-LM developed SMR and were evaluated. The impact of surgical and Ctx re-interventions on recurrence free (RFS) and cancer-specific survival (CSS) was analyzed. Median follow-up was 28.0 (95%CI: 19.4-37.4) months.

RESULTS:

SMR occurred in 81 patients at a single site (49× liver, 18× lung, 14× other) and in 23 patients at multiple sites. Forty-two patients were scheduled for primary surgery. Fifty-three patients were classified as non-resectable and treated with median 5.0 [IQR, 3.0-10.0] cycles of Ctx, combined with an EGFR/VEGF-antibody in 27 patients. Nine patients received best supportive care only. R0/R1 resection could be achieved in 35 patients primarily and even in 8 patients secondarily after Ctx. Surgical morbidity and mortality were 16 and 0%, respectively. The 5-year RFS rates for patients with R0 versus R1-resection were 22 and 24% (p = 0.948). The 5-year CSS rate for R0/R1-resected patients was 38% versus 10% for those patients treated by Ctx alone (p < 0.001).

CONCLUSION:

In SMR, surgical re-intervention is feasible and safe in a remarkable number of patients and offers significantly longer CSS compared to patients without resection.

• Authors: K Homayounfar, A Bleckmann, L C Conradi, T Sprenger, T Lorf, M Niessner, C O Sahlmann, J Meller, T Liersch, B M Ghadimi
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 28 Issue 7 Pg. 1009-17 (Jul 2013) ISSN: 1432-1262 [Electronic] Germany
• PMID: 23371333 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Colorectal Neoplasms (drug therapy, pathology, surgery)
• Female
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (drug therapy, pathology, secondary, surgery)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, pathology, surgery)