Repeated Hepatectomy Improves Survival of Recurrent Metastatic Colon Cancer

NEW YORK JUL 04, 2007 (Reuters Health) - In patients with recurrent metastatic colorectal cancer confined to the liver, repeated hepatectomy is associated with improved survival, according to a report in the Archives of Surgery for June.

"Because the risk and survival benefits approximate those of primary hepatic resection, repeated hepatectomy should be the initial consideration in the multimodal treatment of recurrent hepatic colorectal cancer metastases," lead author Dr. Anton J. Bilchik, from John Wayne Cancer Institute in Santa Monica, California, and colleagues conclude. 

The current findings are based on a review of 64 patients who underwent resection of hepatic metastases and were then treated with irinotecan- or oxaliplatin-based chemotherapy.  The median follow-up period was 40 months. 

The median overall and disease-free survival periods were 60 and 33 months, respectively.  The corresponding 5-year survival rates were 53% and 25%. 

Predictors of worse survival included less than 1 year between colectomy and liver resection, more than 3 metastases, no repeated hepatectomy, and lymph-node positive colorectal cancer.

Nineteen of 28 patients with liver-confined recurrence underwent repeat hepatectomy, the report indicates.  Such patients had a median survival period of 70 months from the time of the first hepatectomy compared with a period of 43 months for patients with a recurrence who did not undergo repeat hepatectomy.  The corresponding 5-year survival rates were 73% and 43%.

Most patients who undergo resection of hepatic metastases from colorectal cancer will "eventually develop recurrence of their disease," the authors note.  "In select patients whose recurrence is confined to the liver, repeated hepatectomy may offer the best chance of long-term survival."

SOURCE:

• Arch Surg 2007;142:526-532.