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

• Published in: International journal of colorectal disease 2013-07, Vol.28 (7), p.1009-1017
• Main Authors: Homayounfar, K., Bleckmann, A., Conradi, L. C., Sprenger, T., Lorf, T., Niessner, M., Sahlmann, C. O., Meller, J., Liersch, T., Ghadimi, B. M.
• Format: Article
• Language: English
• Subjects: Aged; Cancer; Chemotherapy; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Gastroenterology; Health aspects; Hepatology; Humans; Internal Medicine; Kaplan-Meier Estimate; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Mortality; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Original; Original Article; Proctology; Surgery
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-013-1648-2

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