Predictors of early disease recurrence following hepatic resection for colorectal cancer metastasis

Background: With the broadening indications of hepatic resection for colorectal liver metastases (CRLM), the exact group of patients who would benefit from surgery is still debatable. The aim of this study was to identify predictors for early recurrence, defined as recurrence within 6 months of CRLM resection, in order to identify those patients who may require further pre-operative radiological staging of the disease prior to surgery. Methods: Prospectively collected dataset of patients undergoing curative resection for CRLM during the 10-year period (January 1993-May 2003) were analyzed. Patients who received neo-adjuvant chemotherapy and patients who underwent repeat hepatic resections whose primary resection was not performed during the study period were excluded. Results: Four hundred and thirty patients 89%) were included in the analysis. Eighty-six (20%) patients developed early recurrence. Early recurrence was associated with poorer outcome when compared to late recurrences (p < 0.001). The predictor of early recurrence on multivariable analysis was the presence of eight or more metastases (p = 0.036). Conclusion: We have identified a group of patients with multiple metastases who recur early following resection of CRLM. We suggest that these patients should be considered for additional pre-operative radiological workup in the form of PET scanning to identify those patients who would be deemed suitable for resection. (C) 2007 Elsevier Ltd. All rights reserved.