Skip to main content

Advertisement

Log in

Postoperative complications following aggressive repeat hepatectomy for colorectal liver metastasis have adverse oncological outcomes

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purposes

Repeat hepatectomy remains the only curative treatment for recurrent colorectal liver metastasis (CLM) after primary hepatectomy. However, the repeat resection rate is still low, and there is insufficient data on the outcomes after repeat hepatectomy. The aim of this study was to investigate the feasibility and prognostic benefit of aggressive repeat hepatectomy for recurrent CLM.

Methods

Data were reviewed from 282 consecutive patients who underwent primary curative hepatectomy for CLM between January 1994 and March 2015. The short- and long-term outcomes were analyzed.

Results

One hundred ninety-three patients (68 %) developed recurrence, and repeat hepatectomy was conducted in 62 patients. Overall, 62 s, 11 third, 4 fourth, and 1 fifth hepatectomies were performed. The postoperative morbidity and mortality rates were low (11.5 and 1.3 %, respectively). The overall survival rates at 3 and 5 years after primary hepatectomy for CLM in the repeat hepatectomy group were 79.5 and 57.4 %, respectively. A multivariate analysis indicated that postoperative complications were independently associated with overall survival after repeat hepatectomy.

Conclusions

Repeat hepatectomy for CLM is feasible, with acceptable rates of perioperative morbidity and mortality, and the potential for long-term survival. However, postoperative complications following aggressive repeat hepatectomy for CLM are associated with adverse oncological outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94:982–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246:295–300.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Muratore A, Ribero D, Zimmitti G, Mellano A, Langella S, Capussotti L. Resection margin and recurrence-free survival after liver resection of colorectal metastases. Ann Surg Oncol. 2010;17:1324–9.

    Article  PubMed  Google Scholar 

  6. Nordlinger B, Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Allen PJ, Kemeny N, Jarnagin W, DeMatteo R, Blumgart L, Fong Y. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg. 2003;7:109–15.

    Article  PubMed  Google Scholar 

  8. Shindoh J, Tzeng CW, Aloia TA, Curley SA, Zimmitti G, Wei SH, et al. Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival. Br J Surg. 2013;100:1777–83.

    Article  CAS  PubMed  Google Scholar 

  9. Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248:994–1005.

    Article  PubMed  Google Scholar 

  10. Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.

    Article  PubMed  Google Scholar 

  11. Fukami Y, Kurumiya Y, Kobayashi S. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): an analysis of tumor activity. Updates Surg. 2014;66:223–5.

    Article  PubMed  Google Scholar 

  12. Okuno M, Hatano E, Kasai Y, Nishio T, Seo S, Taura K, et al. Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases. Surg Today. 2015 [Epub ahead of print].

  13. Saiura A, Yamamoto J, Koga R, Takahashi Y, Takahashi M, Inoue Y, et al. Favorable outcome after repeat resection for colorectal liver metastases. Ann Surg Oncol. 2014;21:4293–9.

    Article  PubMed  Google Scholar 

  14. Wicherts DA, de Haas RJ, Salloum C, Andreani P, Pascal G, Sotirov D, et al. Repeat hepatectomy for recurrent colorectal metastases. Br J Surg. 2013;100:808–18.

    Article  CAS  PubMed  Google Scholar 

  15. Jones NB, McNally ME, Malhotra L, Abdel-Misih S, Martin EW, Bloomston M, et al. Repeat hepatectomy for metastatic colorectal cancer is safe but marginally effective. Ann Surg Oncol. 2012;19:2224–9.

    Article  PubMed  Google Scholar 

  16. Kulik U, Bektas H, Klempnauer J, Lehner F. Repeat liver resection for colorectal metastases. Br J Surg. 2013;100:926–32.

    Article  CAS  PubMed  Google Scholar 

  17. Battula N, Tsapralis D, Mayer D, Isaac J, Muiesan P, Sutcliffe RP, et al. Repeat liver resection for recurrent colorectal metastases: a single-centre, 13-year experience. HPB (Oxford). 2014;16:157–63.

    Article  PubMed  Google Scholar 

  18. Lam VW, Pang T, Laurence JM, Johnston E, Hollands MJ, Pleass HC, et al. A systematic review of repeat hepatectomy for recurrent colorectal liver metastases. J Gastrointest Surg. 2013;17:1312–21.

    Article  PubMed  Google Scholar 

  19. Stone MD, Cady B, Jenkins RL, McDermott WV, Steele GD Jr. Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg. 1990;125:718–21.

    Article  CAS  PubMed  Google Scholar 

  20. Nordlinger B, Vaillant JC, Guiguet M, Balladur P, Paris F, Bachellier P, et al. Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie. J Clin Oncol. 1994;12:1491–6.

    CAS  PubMed  Google Scholar 

  21. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–8.

    Article  PubMed  Google Scholar 

  24. International Union Against Cancer. TNM classification of malignant tumors. 7th ed. New York: Wiley-Liss; 2009.

    Google Scholar 

  25. Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL, et al. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg. 1998;2:11–20.

    Article  CAS  PubMed  Google Scholar 

  26. Shaw IM, Rees M, Welsh FK, Bygrave S, John TG. Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term survival. Br J Surg. 2006;93:457–64.

    Article  CAS  PubMed  Google Scholar 

  27. Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg. 2008;247:109–17.

    Article  PubMed  Google Scholar 

  28. Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis: improves salvageability and survival. Ann Surg. 2016; 263:146–152

    Article  PubMed  Google Scholar 

  29. Homayounfar K, Bleckmann A, Helms HJ, Lordick F, Rüschoff J, Conradi LC, et al. Discrepancies between medical oncologists and surgeons in assessment of resectability and indication for chemotherapy in patients with colorectal liver metastases. Br J Surg. 2014;101:550–7.

    Article  CAS  PubMed  Google Scholar 

  30. Petrowsky H, Gonen M, Jarnagin W, Lorenz M, DeMatteo R, Heinrich S, et al. Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg. 2002;235:863–71.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yan TD, Lian KQ, Chang D, Morris DL. Management of intrahepatic recurrence after curative treatment of colorectal liver metastases. Br J Surg. 2006;93:854–9.

    Article  CAS  PubMed  Google Scholar 

  32. Thelen A, Jonas S, Benckert C, Schumacher G, Lopez-Hänninen E, Rudolph B, et al. Repeat liver resection for recurrent liver metastases from colorectal cancer. Eur J Surg Oncol. 2007;33:324–8.

    Article  CAS  PubMed  Google Scholar 

  33. Brachet D, Lermite E, Rouquette A, Lorimier G, Hamy A, Arnaud JP. Prognostic factors of survival in repeat liver resection for recurrent colorectal metastases: review of sixty-two cases treated at a single institution. Dis Colon Rectum. 2009;52:475–83.

    Article  PubMed  Google Scholar 

  34. Law WL, Choi HK, Lee YM, Ho JW. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol. 2007;14:2559–66.

    Article  PubMed  Google Scholar 

  35. Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg. 2009;96:81–7.

    Article  CAS  PubMed  Google Scholar 

  36. de Melo GM, Ribeiro KC, Kowalski LP, Deheinzelin D. Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg. 2001;127:828–33.

    PubMed  Google Scholar 

  37. Rizk NP, Bach PB, Schrag D, Bains MS, Turnbull AD, Karpeh M, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg. 2004;198:42–50.

    Article  PubMed  Google Scholar 

  38. Farid SG, Aldouri A, Morris-Stiff G, Khan AZ, Toogood GJ, Lodge JP, et al. Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg. 2010;251:91–100.

    Article  PubMed  Google Scholar 

  39. Mavros MN, de Jong M, Dogeas E, Hyder O, Pawlik TM. Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg. 2013;100:711–8.

    Article  CAS  PubMed  Google Scholar 

  40. Matsuda A, Matsumoto S, Seya T, Matsutani T, Kishi T, Yokoi K, et al. Does postoperative complication have a negative impact on long-term outcomes following hepatic resection for colorectal liver metastasis?: a meta-analysis. Ann Surg Oncol. 2013;20:2485–92.

    Article  PubMed  Google Scholar 

  41. Kulaylat AN, Bhayani NH, Stokes AL, Schubart JR, Wong J, Kimchi ET, et al. Determinants of repeat curative intent surgery in colorectal liver metastasis. J Gastrointest Surg. 2014;18:1894–901.

    Article  PubMed  Google Scholar 

  42. Lundy J, Ford CM. Surgery, trauma and immune suppression. Evolving the mechanism. Ann Surg. 1983;197:434–8.

    Article  CAS  PubMed  Google Scholar 

  43. Horn F, Henze C, Heidrich K. Interleukin-6 signal transduction and lymphocyte function. Immunobiology. 2000;202:151–67.

    Article  CAS  PubMed  Google Scholar 

  44. Wong VK, Malik HZ, Hamady ZZ, Al-Mukhtar A, Gomez D, Prasad KR, et al. C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer. 2007;96:222–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Folprecht G, Gruenberger T, Bechstein WO, Raab HR, Lordick F, Hartmann JT, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11:38–47.

    Article  CAS  PubMed  Google Scholar 

  46. Masi G, Loupakis F, Salvatore L, Fornaro L, Cremolini C, Cupini S, et al. Bevacizumab with FOLFOXIRI (irinotecan, oxaliplatin, fluorouracil, and folinate) as first-line treatment for metastatic colorectal cancer: a phase 2 trial. Lancet Oncol. 2010;11:845–52.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yasuyuki Fukami.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukami, Y., Kaneoka, Y., Maeda, A. et al. Postoperative complications following aggressive repeat hepatectomy for colorectal liver metastasis have adverse oncological outcomes. Surg Today 47, 99–107 (2017). https://doi.org/10.1007/s00595-016-1340-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1340-6

Keywords

Navigation