Predictors of early recurrence after resection of colorectal liver metastases.

James Hodson,Ravi Marudanayagam,John Isaac,Simon Roderick Bramhall,Ricky Harminder Bhogal,Darius Feroze Mirza,Paolo Muiesan,Robert Peter Sutcliffe

doi:10.1186/s12957-015-0549-y

Abstract

BackgroundEarly recurrence after resection of colorectal liver metastases (CLM) is common. Patients at risk of early recurrence may be candidates for enhanced preoperative staging and/or earlier postoperative imaging. The aim of this study was to determine if there are any risk factors that specifically predict early liver-only and systemic recurrence.MethodsRetrospective analysis of prospective database of patients undergoing liver resection (LR) for CLM from 2004 to 2006 was undertaken. Early recurrence was defined as occurring within 18 months of LR. Patients were classified into three groups: early liver-only recurrence, early systemic recurrence and recurrence-free. Preoperative factors were compared between patients with and without early recurrence.ResultsTwo hundred and forty-three consecutive patients underwent LR for CLM. Twenty-seven patients (11%) developed early liver-only recurrence. Dukes C stage and male sex were significantly associated with early liver-only recurrence (P < 0.05). Sixty-six patients (27%) developed early systemic recurrence. Tumour size ≥3.6 cm and tumour number (>2) were significantly associated with early systemic recurrence (P < 0.001).ConclusionsIt is possible to stratify patients according to the risk of early liver-only or systemic recurrence after resection of CLM. High-risk patients may be candidates for preoperative MRI and/or computed tomography-positron emission tomography (CT-PET) scan and should receive intensive postoperative surveillance.

Highlights

Recurrence after resection of colorectal liver metastases (CLM) is common
Patients and data collection and statistical analysis We reviewed our prospectively held departmental database to identify all patients who had undergone liver resection (LR) for CLM between January 2004 and December 2006 inclusive
In patients with early liver-only recurrence, 19 patients (70%) had treatable lesions, and 8 patients were suitable for palliative treatment only

Summary

Introduction

Recurrence after resection of colorectal liver metastases (CLM) is common. Patients at risk of early recurrence may be candidates for enhanced preoperative staging and/or earlier postoperative imaging. Recurrence after resection of colorectal liver metastases is common, developing in the liver remnant in up to 30% of patients [7,8] and at extra-hepatic locations in up to 50% [9,10,11,12]. Recurrence may be due to aggressive tumour biology, inadequate surgical resection and/or failure of systemic therapy and may be an indication of suboptimal pre-operative staging. Contrast-enhanced computed tomography (CT) is the imaging modality of choice for staging patients with liver metastases and for postoperative monitoring.

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