Long Term Follow up Strategy for CRLM Following Liver Resection

Abstract

Introduction: Liver resection for colorectal liver metastasis (CRLM) can be achieved with curative intent in 10 – 20% of these cases, and 5 year survival is approaching 50%. There is evidence that those patients who survive beyond 10 years are effectively cured of their disease. Currently there are no consensus guidelines regarding long term follow up for patients who have undergone liver resection for CRLM. Methods: We retrospectively analysed all patient undergoing at least one repeat liver resection for recurrent CRLM at our instution since 1997. We assessed time between resections as a marker of time to recurrence. Results: In total 279 patients underwent at least 2 liver resections for recurrent CRLM. Some patients went on to have third and fourth resections for recurrent CRLM. In total 279 patients underwent 348 resections. Median time to recurrence between resections was; 15.5 months (n=279) to second recurrence, 15.7 months to third recurrence (n=59), and 20.7 months to 4threcurrence (n=10). Overall 96.6 of patients recurred within 5 years. There were 12 (3.4%) patients who recurred after 5 years. Conclusion: This study demonstrates that the majority of recurrent CRLM occurs within the first 5 years following liver resection. There are a small proportion of patients that recur after 5 years that still have a potential benefit from surgery. We recommend that follow up for patients undergoing liver resection for CRLM should be for 10 years in selected patients, in particular those that are fit enough for consideration of further surgery