Early Recurrence After Liver Resection for Colorectal Metastases: Risk Factors, Prognosis, and Treatment. A LiverMetSurvey-Based Study of 6,025 Patients View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-12-18

AUTHORS

Luca Viganò, Lorenzo Capussotti, Réal Lapointe, Eduardo Barroso, Catherine Hubert, Felice Giuliante, Jan N. M. Ijzermans, Darius F. Mirza, Dominique Elias, René Adam

ABSTRACT

PurposeThe aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management.MethodsPatients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection.ResultsA total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3–4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028).ConclusionsEarly recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated. More... »

PAGES

1276-1286

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-013-3421-8

DOI

http://dx.doi.org/10.1245/s10434-013-3421-8

DIMENSIONS

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PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24346766


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30 schema:description PurposeThe aims of this study were to assess the risk of early recurrence after liver resection for colorectal metastases (CRLM) and its prognostic value; identify early recurrence predictive factors; clarify the effect of perioperative chemotherapy on its occurrence; and elucidate the best early recurrence management.MethodsPatients of the LiverMetSurvey registry who underwent complete liver resection (R0/R1) between 1998 and 2009 were reviewed. Early recurrence was defined as any recurrence that occurred within 6 months after resection.ResultsA total of 6,025 patients were included; 2,734 (45.4 %) had recurrence, including 639 (10.6 %) early recurrences. Early recurrence was mainly hepatic (59.5 vs. 54.4 % for late recurrences; p = 0.023). Independent risk factors of early recurrence were: T3–4 primary tumor (p = 0.0002); synchronous CRLM (p = 0.0001); >3 CRLM (p < 0.0001); 0-mm margin liver resection (p = 0.003); and associated intraoperative radiofrequency ablation (p = 0.0005). Response to preoperative chemotherapy (complete/partial) and administration of adjuvant chemotherapy reduced early recurrence risk (p = 0.003 and p < 0.0001, respectively). Intraoperative ultrasonography reduced hepatic early recurrence rate (p = 0.025). Early recurrence negatively affected prognosis: 5-year survival 26.9 versus 49.4 % for the late recurrence group (p < 0.0001, median follow-up 34.4 months). Overall, 234 (36.6 %) patients with early recurrence underwent re-resection. These patients had survival rates higher than non-re-resected patients (5-year survival 47.2 vs. 8.9 %; p < 0.0001) and similar to re-resected patients for late recurrence (48.7 %). Chemotherapy before early recurrence resection improved later survival (5-year survival 61.5 vs. 43.7 %; p = 0.028).ConclusionsEarly recurrence risk is enhanced for extensive disease after poor preoperative disease control and inadequate surgical treatment, but is reduced after adjuvant chemotherapy. Although early recurrence negatively affects prognosis, re-resection may restore better survival. Chemotherapy before early recurrence resection is advocated.
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36 schema:keywords LiverMetSurvey
37 LiverMetSurvey registry
38 MethodsPatients
39 ResultsA total
40 ablation
41 adjuvant chemotherapy
42 administration
43 aim
44 better survival
45 chemotherapy
46 colorectal metastases
47 complete liver resection
48 control
49 disease
50 disease control
51 early recurrence
52 early recurrence rate
53 early recurrence risk
54 effect
55 extensive disease
56 factors
57 group
58 inadequate surgical treatment
59 independent risk factor
60 intraoperative radiofrequency ablation
61 intraoperative ultrasonography
62 late recurrence
63 late recurrence group
64 late survival
65 liver resection
66 management
67 metastasis
68 months
69 occurrence
70 patients
71 perioperative chemotherapy
72 predictive factors
73 preoperative chemotherapy
74 primary tumor
75 prognosis
76 prognostic value
77 radiofrequency ablation
78 rate
79 re-resected patients
80 recurrence
81 recurrence group
82 recurrence management
83 recurrence rate
84 recurrence resection
85 recurrence risk
86 registry
87 resection
88 response
89 risk
90 risk factors
91 study
92 surgical treatment
93 survival
94 survival rate
95 synchronous colorectal metastases
96 total
97 treatment
98 tumors
99 ultrasonography
100 values
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