Abstract
Recurrence following curative-intent hepatectomy for colorectal cancer liver metastasis, hepatocellular carcinoma, or cholangiocarcinoma is unfortunately common with a reported incidence as high as 75%. Various treatment modalities can improve survival following disease recurrence. A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage liver transplantation for recurrent hepatocellular carcinoma is another option, which has been associated with a 5-year survival of 50%. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location. For patients with inoperable disease, transarterial chemoembolization, or radioembolization with Yttrium-90 are liver-directed intra-arterial therapy modalities with relatively low risks that can be utilized. Stereotactic body radiation therapy is another palliative treatment option that can provide a response and local tumor control for smaller tumors.
Highlights
Colorectal cancer is the third most common cancer worldwide with the liver being the most common site of metastatic disease and primary liver cancer is the sixth most common cancer worldwide making the liver a very common site of disease [1]
Prognostic factors associated with increased risk of recurrence or worse survival following repeat hepatectomy are a history of synchronous liver metastasis, an initial Cancer Liver Metastasis (CRLM) ≥5 cm, positive surgical margins at initial resection, a relapse-free interval of less than one year, the presence of multiple liver lesions or extrahepatic disease at the time of second hepatectomy, and positive surgical margins at repeat hepatectomy [27, 36, 38, 39]
Repeat resection may be associated with better local disease control for larger tumors > 3 cm in diameter; RFA, had similar efficacy to repeat hepatectomy for smaller tumors measuring ≤ 3 cm in diameter. While these findings suggest that repeat hepatectomy and ablation may have equivalent efficacy for recurrent tumors ≤ 3 cm, additional studies comparing outcomes between repeat hepatectomy and ablation stratified by the number and size of recurrent tumors may better clarify the optimal therapeutic approach
Summary
A review of the literature was performed using PubMed. In addition to systemic therapy, liver-directed treatment options for recurrent liver disease include repeat hepatectomy, salvage liver transplantation, radiofrequency or microwave ablation, intra-arterial therapy, and stereotactic body radiation therapy. Repeat resection can be consider for patients with limited recurrent disease that meets resection criteria, as this therapeutic approach can provide a survival benefit and is potentially curative in a subset of patients. Salvage transplantation may be an option in particular for patients who are not candidates for resection due to underlying liver dysfunction but meet criteria for transplantation. Ablation is another modality to treat patients who recur with smaller tumors and are not surgical candidates due to comorbidity, liver dysfunction, or tumor location.
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