Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases

Hypothesis: Multimodal treatment consisting of repeated hepatectomy and adjuvant systemic chemotherapy for liver-confined recurrence of colorectal cancer can yield long-term survival comparable with that associated with primary hepatectomy. Design: Retrospective analysis. Setting: A prospective database at a tertiary referral cancer center. Patients: Review of 274 consecutive liver resections identified 64 patients who underwent resection of hepatic colorectal metastases without ablation followed by adjuvant irinotecan hydrochloride- or oxaliplatin-based systemic chemotherapy. Main Outcome Measures: Median and 5-year overall and disease-free survival after primary and repeated hepatectomy. Results: At median follow-up of 40 months, median and 5-year overall survival after hepatectomy were 60 months and 53%, respectively; median and 5-year disease-free survival were 33 months and 25%, respectively. Multivariate analysis showed that less than 1 year between colectomy and liver resection (P=.001), more than 3 metastases (P=.001), no repeated hepatectomy (P=.01), and lymph node-positive primary colon cancer (P=.02) were independently predictive of worse survival. Of 28 patients (44%) with liver-confined recurrence, 19 (30%) underwent repeated hepatectomy; at median follow-up of 38 months, median and 5-year overall survival after repeated hepatectomy were 48 months and 44%, respectively. No risk factors were identified in multivariate analysis. In patients with recurrence, median and 5-year overall survival measured from primary hepatectomy were 70 months and 73%, respectively, with repeated hepatectomy vs 43 months and 43%, respectively, without repeated hepatectomy (P=.03). Conclusion: Multimodal treatment of recurrent colorectal cancer confined to the liver should begin with consideration of repeated hepatectomy.