Repeat resection of recurrent hepatic metastases--improvement in prognosis?

OBJECTIVE

To find out if resection of recurrent hepatic metastases improves survival.

DESIGN

Retrospective study.

SETTING

University hospital, Germany.

SUBJECTS

25 patients who had recurrent metastases after radical resection of hepatic metastases from colorectal and other primary carcinomas.

INTERVENTIONS

Repeat liver resection with the intention to cure. Limited hepatic resections were preferred if they could be done without loss of radicality.

MAIN OUTCOME MEASURES

Operative morbidity and mortality, survival time after second hepatic resection, analysis of possible prognostic factors.

RESULTS

Hemihepatectomy was done for 4 patients, and infiltration of the diaphragm led to extended resections in a further 4. Locoregional recurrence of rectal carcinoma together with a solitary pulmonary metastases in another patient were removed simultaneously. The remainder were limited resections. Seventeen procedures were regarded as radical. There were no operative deaths, and five patients developed minor complications. Actuarial survival rates after radical repeat liver resections were 94% after one year, 53% after two years, and 24% after three years. Radicality was the main prognostic factor of survival.

CONCLUSIONS

Repeat hepatic resections seem to improve prognosis and are recommended in patients with recurrent metastases confined to the liver.