Predictors of early liver-only and systemic recurrence following liver resection for colorectal metastases

Abstract

Introduction: Early recurrence remains a major problem following liver resection (LR) for colorectal liver metastasis (CRLM). Understanding the factors that are associated with liver-only and/or systemic recurrence will assist in developing more effective post-operative surveillance protocols. The aim of this study was to investigate risk factors for early liver-only and systemic recurrence. Methods: Retrospective review of a prospectively maintained database of patients undergoing first LR between 2005 and 2015 for CRLM. Early recurrence was defined as disease recurrence within 6 months following LR. A multivariable logistic regression model identified independent predictors of early-recurrence. Results: 682 patients were included in the study. 48 patients (7%) had liver-only early disease recurrence and 40 (6%) had systemic recurrence. Median overall survival (in months) was lower for the recurrence groups (liver-only 20 [Interquartile range:17-23] and systemic 19 [14-24] vs. no-recurrence 43 [37-45], both p< 0.001). Multivariable analyses showed lymph node status of the primary tumour (LNS) (p=0.003) and positive microscopic resection margins (R1) (p=0.010) were independent risk factors for liver-only recurrence, whereas LNS (p=0.002), major LR (≥3 Couinaud segments) (p=0.038) and summative histopathological tumour diameter (p=0.005) were independent risk factors for systemic recurrence. Adjuvant chemotherapy (AC) significantly reduced liver-only recurrence (p=0.029). Conclusion: Early liver-only and systemic recurrence after LR for CRLM significantly decreased overall patient survival and were associated with LNS. Early liver-only recurrence was associated with R1 resection and patients benefit from AC. Early-systemic recurrence was associated with high hepatic tumour burden. These findings could guide post-operative imaging protocols to detect early-disease recurrence.