Affiliation:
1. Department of Surgery The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio USA
2. Department of Surgery University of Verona Verona Italy
3. Department of Surgery Ospedale San Raffaele Milan Italy
4. Department of Surgery Fundeni Clinical Institute Bucharest Romania
5. Department of Surgery Keio University Tokyo Japan
6. Department of Surgery Stanford University Stanford California USA
7. Department of General Surgery Cleveland Clinic Foundation Cleveland Ohio USA
Abstract
AbstractIntroductionApproximately 15% of patients experience a resectable intrahepatic recurrence after an index curative‐intent hepatectomy for colorectal liver metastases (CRLM). We sought to investigate the impact of recurrence timing and tumor burden score (TBS) at the time of recurrence on overall survival among patients undergoing repeat hepatectomy.MethodsPatients with CRLM who experienced recurrent intrahepatic disease after initial hepatectomy between 2000 and 2020 were identified from an international multi‐institutional database. The impact of time–TBS, defined as TBS divided by the time interval of recurrence, was assessed relative to overall survival.ResultsAmong 220 patients, the median age was 60.9 years (interquartile range [IQR]: 53.0–69.0), and 144 (65.5%) patients were male. Most patients experienced multiple recurrences (n = 120, 54.5%) within 12 months after the initial hepatectomy (n = 139, 63.2%). The median tumor size of the recurrent CRLM was 2.2 cm (IQR: 1.5–3.0 cm) with a median TBS of 3.5 (2.3–4.9) at the time of recurrence. Overall, 121 (55.0%) patients underwent repeat hepatectomy, whereas 99 (45.0%) individuals were treated with systemic chemotherapy or other nonsurgical treatments; repeat hepatectomy was associated with better postrecurrence survival (PRS) (p < 0.001). Three‐year PRS incrementally worsened (low time–TBS: 71.7%, 95% confidence interval [CI], 57.9‐88.8 vs. medium: 63.6%, 95% CI, 47.7–84.8 vs. high: 49.2%, 95% CI, 31.1–77.7, p = 0.02) as time–TBS values increased. Each unit increase in time–TBS score was independently associated with a 41% higher possibility of death (hazard ratio: 1.41; 95% CI, 1.04–1.90, p = 0.03).ConclusionsTime–TBS was associated with long‐term outcomes after repeat hepatectomy for recurrent CRLM. Time–TBS may be an easy tool to help select patients who may benefit the most from repeat hepatic resection of recurrent CRLM.
Subject
Oncology,General Medicine,Surgery