Hepatectomy For Colorectal Liver Metastases Research Articles

Noncolorectal, Nonneuroendocrine Liver Metastasis

Noncolorectal, nonneuroendocrine metastases represent a heterogeneous group with variable tumor biology. Successes in the use of hepatectomy for colorectal liver metastases has increased interest in resection of noncolorectal, nonneuroendocrine metastases. Cure rates equivalent to those of colorectal liver metastases have not been achieved, but resection of noncolorectal, nonneuroendocrine metastases can often provide improved overall survival compared with systemic therapy alone or exclusively palliative care. Overall survival outcomes can be achieved with acceptable perioperative morbidity and mortality relative to rates for hepatectomies in general. Prospective data regarding the utilization of resection for noncolorectal, nonneuroendocrine metastases are lacking, but retrospective data are encouraging. In appropriately selected patients with favorable tumor biology and excellent performance status, resection of noncolorectal, nonneuroendocrine may offer a survival benefit. This review contains 1 figure, 2 tables, and 31 references. Key Words: breast cancer, cytoreduction, gastric cancer, GIST, hepatectomy, melanoma, metastasis, ovarian cancer, pancreatic cancer, renal cell carcinoma

Noncolorectal, Nonneuroendocrine Liver Metastasis

Noncolorectal, nonneuroendocrine metastases represent a heterogeneous group with variable tumor biology. Successes in the use of hepatectomy for colorectal liver metastases has increased interest in resection of noncolorectal, nonneuroendocrine metastases. Cure rates equivalent to those of colorectal liver metastases have not been achieved, but resection of noncolorectal, nonneuroendocrine metastases can often provide improved overall survival compared with systemic therapy alone or exclusively palliative care. Overall survival outcomes can be achieved with acceptable perioperative morbidity and mortality relative to rates for hepatectomies in general. Prospective data regarding the utilization of resection for noncolorectal, nonneuroendocrine metastases are lacking, but retrospective data are encouraging. In appropriately selected patients with favorable tumor biology and excellent performance status, resection of noncolorectal, nonneuroendocrine may offer a survival benefit. This review contains 1 figure, 2 tables, and 31 references. Key Words: breast cancer, cytoreduction, gastric cancer, GIST, hepatectomy, melanoma, metastasis, ovarian cancer, pancreatic cancer, renal cell carcinoma

Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases

ObjectiveThis study assessed predictors of survival after repeat hepatectomy and the feasibility of a repeat hepatectomy after a major hepatectomy in the patients with colorectal liver metastases (CLM). BackgroundMore than half of all patients who receive a curative initial hepatectomy for CLM develop hepatic recurrence, and aggressive indications for a repeat hepatectomy can improve the outcome in selected patients. However, the feasibility of repeat hepatectomy after major hepatectomy remains uncertain, and optimal selection criteria for repeat hepatectomy have not yet been established. MethodsData were collected retrospectively on 296 CLM patients who underwent an initial curative hepatectomy between 2007 and 2017 at our institution. The postoperative outcomes of patients undergoing a repeat hepatectomy after major hepatectomy were assessed, and independent predictors of survival were investigated. ResultsAfter a median follow-up period of 32 months, 247 patients (83%) developed disease recurrence and 122 patients (49%) underwent repeat hepatectomy. The 5-year overall survival (OS) was significantly higher in patients who underwent a repeat hepatectomy than in those who did not receive repeat hepatectomy (51% vs. 19%, respectively; P < 0.001). In a multivariate analysis, an extrahepatic lesion at the time of the repeat hepatectomy (HR, 2.49; P = 0.001) and 5 or more liver tumors at the time of recurrence (HR, 1.88; P = 0.04) remained as independent factors negatively affecting OS after repeat hepatectomy. The type of operative procedure and the intraoperative and postoperative factors at the time of the initial hepatectomy did not have any significant influence on the OS after repeat hepatectomy. No significant difference in OS was found between patients who received repeat hepatectomy after major hepatectomy (n = 43) and those after non-major hepatectomy (n = 79). ConclusionsThe operative procedure and the liver tumor status at the time of the initial hepatectomy have little impact on the indications for a repeat hepatectomy for recurrent CLM. Repeat hepatectomy is feasible even if major hepatectomy was initially performed.

Non-alcoholic fatty liver disease is an independent predictor of recurrence after resection of colorectal liver metastases

Background: Obesity and metabolic syndrome have been associated with increased risk for recurrence after hepatic resection of colorectal liver metastases (CRLM). Although previous studies of hepatic fibrosis and fatty liver disease suggest a protective effect against intrahepatic recurrence (IHR), the impact of non-alcoholic fatty liver disease (NAFLD) on recurrence patterns has not been well-defined. Methods: Histologic evaluation of hepatic parenchymal disease was quantified using the validated NAFLD activity score (NAS) including sinusoidal dilatation, hepatic steatosis, and fibrosis for 365 CRLM patients undergoing hepatic resection between April 2003 and March 2007. These were compared to clinicopathologic factors, intraoperative findings including surgeon evaluation of gross hepatic appearance (normal, fatty, or fibrotic) and outcomes. Fisher’s exact test was used to examine the association between substantial NAFLD, defined as NAS ≥ 3, and other clinical characteristics with gross hepatic appearance. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Cumulative incidence of recurrence patterns (any intrahepatic recurrence (IHR), extrahepatic recurrence only (EHR), and death without recurrence (DWR), were estimated using competing risks methods and compared using Fine and Gray regression. Results: Intraoperative hepatic appearance was not associated with NAFLD (p=0.16), body mass index (BMI) > 25 (p = 0.23), diabetes (p = 0.56), or chemotherapy (5-FU, FOLFIRI, FOLFOX, FOLFIRINOX, p = 0.73, 0.10, 0.43, 0.52, respectively). Median follow-up was 54.1 months (range:1–178). Five-year RFS was 29% (95%CI = 25–34%). Five-year cumulative incidence for IHR, EHR, and DWR were 35%, 26%, and 9% respectively. After controlling for known clinical confounders, NAFLD remained significantly associated with the risk of IHR (HR = 1.83, 95%CI = 1.08-3.10, p = 0.02, Figure 1). NAFLD (HR = 0.19 95%CI=0.05-0.78, p = 0.02), tumor size >5cm (HR = 1.87, 95%CI = 1.15-3.05, p = 0.01), and hepatic artery infusion chemotherapy (HR = 1.59, 95%CI = 1.05–2.41, p = 0.03) were independently associated with risk of EHR. NAFLD was not associated with OS (HR = 0.91, 95%CI = 0.59–1.40, p = 0.665), however, tumor size > 5cm (HR = 1.73, 95%CI = 1.28–2.34, p 200 (HR = 2.28, 95%CI = 1.35–3.86, p 3 (HR = 2.10, 95%CI = 1.56–2.83, p < 0.01) were associated with OS on univariate analysis. Conclusion: Intraoperative hepatic appearance during hepatectomy for CRLM is not associated with the histologic presence of NAFLD. Although NAFLD was not associated with OS, it was an independent predictor of time to IHR. NAFLD may create a tumorigenic milieu supportive of IHR. The presence of NAFLD offers prognostic information for risk of timing and location of recurrent disease.

The impact of posthepatectomy liver failure on long-term survival after hepatectomy for colorectal liver metastasis

BackgroundPostoperative complications affect both the short-term and long-term outcomes. The aim of this study was to identify specific prognostic factors among complications after hepatectomy for colorectal liver metastasis (CRLM). MethodsBetween 2002 and 2014, 427 patients underwent initial hepatectomy for CRLM. The clinicopathological parameters including postoperative complications were evaluated to identify the prognostic factors for the overall (OS) and relapse-free survival (RFS). ResultsOne hundred and forty-nine patients (34%) developed postoperative complications, including surgical site infection (n = 49, 11.4%), bile leakage (n = 41, 9.6%), posthepatectomy liver failure (PHLF) (n = 26, 6.0%), and pulmonary complication (n = 20, 4.6%). The independent predictors of RFS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, bilateral CRLMs, ≥5 CRLMs, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year RFS rates in patients with and without PHLF were 8% and 32%, respectively (P < 0.001). The independent prognostic factors for OS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, positive surgical margins, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year OS rates in patients with and without PHLF were 31% and 63%, respectively (P = 0.004). ConclusionsAmong the complications, only PHLF was associated with decreased long-term survival after hepatectomy for CRLM as well as tumor-specific prognostic factors.

Impact of Surgical Treatment for Recurrence After 2-Stage Hepatectomy for Colorectal Liver Metastases, on Patient Outcome.

To evaluate the impact of repeat surgery for recurrence on the long-term survival after 2-stage hepatectomy (TSH) for extensive colorectal liver metastases (CRLM). Although TSH is now deemed effective for selected patients with extensive bilobar CRLM, disease recurrence after TSH is very frequent because of the extensive tumor load. Among a total cohort of 1235 patients who underwent hepatectomy for CRLM between 1992 and 2012, 139 with extensive bilobar CRLM were scheduled for TSH. Of these, 93 patients had completion of TSH and were enrolled in this study. The 5-year overall survival (OS) rate after TSH was 41.3%. Twenty-two patients (23.7%) had a concomitant extrahepatic disease (EHD), and curative resection of concomitant EHD was achieved in 13 patients. Among the 81 patients who achieved complete tumor removal for primary, CRLM, and concomitant EHD, 62 (76.5%) had recurrence. Repeat surgery was performed in 38 patients; 35 for recurrence after curative surgery and 3 for liver recurrence with unresected concomitant EHD or primary tumor. Of these 38 patients, 31 were salvaged. The patients who underwent repeat surgery had a significantly longer OS than those who did not (45.8% vs 26.3%; P = 0.0041). A multivariate analysis revealed that repeat surgery was an independent prognostic factor of the OS after TSH (hazard ratio 0.31, P = 0.0012). Repeat surgery for recurrence after TSH may be crucial for the long-term survival in patients with extensive bilobar CRLM. Intensive oncosurgical surveillance is essential to avoid missing the chance for repeat surgery after TSH.

Surgical outcomes of two-stage hepatectomy for colorectal liver metastasis: comparison to a benchmark procedure.

Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant. The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE, and to critically review the selection criteria for TSH-PVE. A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007-2017 was performed. Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy (RH) only. Twenty-nine patient underwent TSH, 25 of whom (86.2%) completed both stages. These patients demonstrated a major complication rate of 17%, and a 90-day mortality rate of 3.4%. Most complications (80%) were related to the colonic resection, and one patient developed liver failure. Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions. Ablative techniques were utilized in 76%. When compared to 35 patients who underwent sole RH, no significant difference was demonstrated in major complication rate (20%) or mortality (0%). TSH is a relatively safe procedure in selected patients. Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible. Factors such as number of lesions, comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.

Two-stage hepatectomy for colorectal liver metastasis

Two-stage hepatectomy for colorectal liver metastasis

Prognostic role of KRAS mutational status and response to preoperative chemotherapy in patients undergoing hepatectomy for colorectal liver metastases

Background: Both pattern of response to preoperative chemotherapy (pCHT) and KRAS mutational status are associated with survival following hepatectomy for colorectal liver metastases (CLM). The current study aims at investigating the prognostic role of these two factors in a large cohort of patients from a single high volume hospital. Methods: Data on 281 patients with a known KRAS mutation status who underwent curative resection for CLM after pCHT were reviewed. Recurrence-free (RFS) and disease-specific survival (DSS) were compared according to KRAS mutational status (mutated (mutKRAS) vs wild-type (wtKRAS)) and to response to pCHT (progression/stability (PD/SD) vs partial/complete response (PR/CR)). Results: At univariate analysis, mtKRAS and PD/SD after pCHT were associated with significantly shorter RFS (p=.015 and p=.024, respectively) and DSS (p=.026 and p=.006, respectively) and independently predicted an higher risk of recurrence (Hazard-Ratio(HR)=1.6 and 1.4,respectively) and mortality (HR=2.1 and 1.6,respectively). Subgroup analysis showed that, among patients with PD/SD after pCHT, mtKRAS was still associated with poorer outcomes both at the univariate and multivariate analysis (all p<.05), compared to wtKRAS. Conclusion: mtKRAS and lack of response to pCHT are both independently associated with poor survival outcomes after CLM resection. KRAS mutational status may further stratify survival among patients not responding to pCHT.

Prognostic role of KRAS mutational status and response to preoperative chemotherapy in patients undergoing hepatectomy for colorectal liver metastases

Background: Both pattern of response to preoperative chemotherapy (pCHT) and KRAS mutational status are associated with survival following hepatectomy for colorectal liver metastases (CLM). The current study aims at investigating the prognostic role of these two factors in a large cohort of patients from a single high volume hospital. Methods: Data on 281 patients with a known KRAS mutation status who underwent curative resection for CLM after pCHT were reviewed. Recurrence-free (RFS) and disease-specific survival (DSS) were compared according to KRAS mutational status (mutated (mutKRAS) vs wild-type (wtKRAS)) and to response to pCHT (progression/stability (PD/SD) vs partial/complete response (PR/CR)). Results: At univariate analysis, mtKRAS and PD/SD after pCHT were associated with significantly shorter RFS (p=.015 and p=.024, respectively) and DSS (p=.026 and p=.006, respectively) and independently predicted an higher risk of recurrence (Hazard-Ratio(HR)=1.6 and 1.4,respectively) and mortality (HR=2.1 and 1.6,respectively). Subgroup analysis showed that, among patients with PD/SD after pCHT, mtKRAS was still associated with poorer outcomes both at the univariate and multivariate analysis (all p<.05), compared to wtKRAS. Conclusion: mtKRAS and lack of response to pCHT are both independently associated with poor survival outcomes after CLM resection. KRAS mutational status may further stratify survival among patients not responding to pCHT.

FBXW7 mutation is associated with decreased survival following hepatectomy for metastatic colorectal cancer

Introduction: Improved understanding of tumor genomics has transformed the treatment of colorectal liver metastases (CLM). F-box/WD repeat-containing protein 7 (FBXW7) is a tumor suppressor gene recognized in the degradation of mediators of cell cycle progression. We have previously reported the effect of frequently mutations in the setting of CLM, however the role of FBXW7 in the progression of this disease is underreported. We aimed to evaluate the impact of FBXW7 mutation on survival following hepatectomy for CLM. Method: Clinicopathologic data was abstracted for patients with documented mutational analysis who underwent hepatectomy from 2001-2016. Kaplan-Meier analysis was performed for overall survival (OS) and compared by log-rank test. Risk factors for overall survival were determined by Cox proportional hazards model. Result: In total, 462 patients were included with a median age of 55 years (IQR 46-62 years). Most had colon primary tumors (68.5%), were ≥T3 (87.5%), and had lymph node-positive primary disease (70.9%). Synchronous metastasis occurred in 76.5%, yet the minority had extrahepatic metastases (16.6%). Most (90.5%) underwent neoadjuvant chemotherapy, with 71% of these receiving concomitant targeted therapy. Few patients (20.4%) underwent R1 resection. The most common mutation associated with survival was TP53 (prevalence: 70.7%,HR:2.0, 95%CI 1.4-3.0, p<0.001), followed byRAS (50.4%, HR:2.4, 95%CI 1.7-3.5, p<001). Mutation in FBXW7 was found in 5.7% of patients, and it was a strong negative prognostic factor for OS (HR 1.99, p=0.015). BRAF was the least common mutation, found in 2.3%, but it was the strongest negative prognostic factor for OS (HR 2.47, p=0.023). Conclusion: Mutation of FBXW7 is a strong negative predictor of OS and is detected more frequently than other accepted mutations used for prognostication following hepatectomy for CLM. Further analyses of FBXW7 in combination with additional mutations and clinical factors may refine risk stratification and treatment decisions for patients with CLM.

Laparoscopic left liver resections and right portal vein ligation: first step of two stage hepatectomy for colorectal liver metastases

Laparoscopic left liver resections and right portal vein ligation: first step of two stage hepatectomy for colorectal liver metastases

Development and internal validation of a nomogram with excellent discrimination and calibration statistics for predicting long-term survival after hepatectomy for colorectal liver metastases

Development and internal validation of a nomogram with excellent discrimination and calibration statistics for predicting long-term survival after hepatectomy for colorectal liver metastases

The Surgical Benefits of Repeat Hepatectomy for Colorectal Liver Metastasis

The Surgical Benefits of Repeat Hepatectomy for Colorectal Liver Metastasis

Laparoscopic right hepatectomy after portal vein ligation: second step of two stage hepatectomy for colorectal liver metastases

Laparoscopic right hepatectomy after portal vein ligation: second step of two stage hepatectomy for colorectal liver metastases

Estimated remnant liver function prior to hepatectomy for CR metastasis is a better predictor of post-hepatectomy liver failure than APRI score.

Background: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate. The future remnant liver volume (FLRV%) and the total liver function both influence the occurrence of PHLF. Total liver function can be reduced in chemotherapy associated liver injury (CALI). Different tools predicting PHLF have been described in hepatectomy for colorectal liver metastasis after chemotherapy. Aspartate aminotransferase to platelet ratio index (APRI) has been shown to predict CALI and PHLF related to severe CALI. Estimation of the future liver remnant function (eFLRF) in a formula combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBS) and FLRV% liver volumetry has been shown to predict PHLF. No direct comparison between eFLRF and APRI has been performed up to now. Methods: Estimation of the future liver remnant function (eFLRF) was performed in 140 patients prior to liver resection for colorectal liver metastasis after preoperative systemic therapy. When the cut-off for eFLRF was under 2.3%/min/m2, portal vein embolization or ligation was performed. APRI scores was calculated in all patients. Results: In ROC analysis, FLRV% and eFLRF had a better predictive value for PHLF than HBS alone and APRI. In multivariate analysis, eFLRF seems to be the only predicting factor for PHLF. Conclusion: PHLF is best predicted by combining volumetry with liver function in one formula than by separate volumetric or functional evaluation of the liver.

Laparoscopic right hepatectomy after portal vein ligation: second step of two stage hepatectomy for colorectal liver metastases

Background: Hepatic resection is the treatment of choice for patients with colorectal liver metastases but 75- 85% of patients are unresectable at diagnosis. Many patients with multiple bilobar metastases are not eligible for surgery because of the small future remnant liver (FRL). Patients with impaired hepatic function, scheduled for extended hepatectomy are at greater risk of liver failure. Methods: Two stage hepatectomy (TSH) is a strategy designed to increase the number of patients who may benefit from liver surgery while reducing the risk of postoperative liver failure. Right hepatectomy is now frequently performed laparoscopically, but it may be challenging in the setting of two stage hepatectomy, after left liver clearance and portal vein ligation. Results: The video shows the case of a patient in whom TSH is completed with a laparoscopic right hepatectomy after laparoscopic left liver clearance and PVL. FLR had increased to 49% after portal vein alcohol injection and PLV performed during the first stage. Right hepatic vein is dissected at the caval confluence. Dissection of the right side of the liver pedicle is rather difficult because of the previous PVL. Right hepatic artery and right portal vein are clipped and divided. Parenchimal section is performed with ultrasound dissector. Right bile duct is stapled intraparenchimally. Right hepatectomy is concluded with section of the right hepatic vein. Conclusion: Two stage hepatectomy can performed entirely in laparoscopy in selected patients.

Surgical and oncological outcomes after hepatectomy for colorectal liver metastasis in patients with autologous blood transfusion: a single-institute retrospective analysis

Introduction: Although preoperative autologous blood donation (ABD) is a useful alternative to allogeneic blood transfusion, the need for it during liver surgery has decreased because hepatectomies have become safer. Moreover, there is concern over the possibility that the blood contains cancer cells. In this retrospective study, the perioperative and oncological outcomes of patients with colorectal liver metastasis (CRLM) who received autologous blood transfusion (ABT) were investigated. Method: Between January 2006 and December 2015, patients who underwent R0 or R1 hepatectomy for CRLM at our institute were included and those with repeat or synchronous hepatectomy were excluded. The incidence of allogeneic red blood cell (RBC) transfusion, changes in hemoglobin (Hb) values, recurrence-free survival (RFS), and overall survival (OS) were compared among 37 patients who received ABT (ABT group) and 35 patients who did not receive ABT (non-ABT group). Result: Allogeneic RBCs were transfused into 1 patient (2.5%) with ABD and into 5 patients (15.6%) without ABD (p = 0.045). Although preoperative Hb values were lower in patients with ABD than in patients without ABD (p = 0.047), those on postoperative day 7 were higher in patients with ABD than in patients without ABD (11.5 ± 1.2 vs. 10.5 ± 1.6 g/dL; p = 0.021). Median RFS did not significantly differ between the ABT and non-ABT groups (p = 0.714), and the two-year OS was 72.2% and 60.2%, respectively (p = 0.527). Conclusion: In patients with CRLM, ABT reduced the incidence of allogeneic RBC transfusion and did not worsen postoperative oncological outcomes.

Two-stage hepatectomy for colorectal liver metastases: Pathologic response to preoperative chemotherapy is associated with second-stage completion and longer survival

Two-stage hepatectomy of bilobar colorectal liver metastases is widely used and shows encouraging survival results. However, the risk of dropout after the first stage remains high and is associated with poor survival. The objective of our study was to evaluate the factors associated with long-term survival based on the pathologic response to preoperative systemic chemotherapy in colorectal liver metastases patients who underwent two-stage hepatectomy. The pathologic response to preoperative chemotherapy and its effect on second-stage completion and survival were retrospectively evaluated in 67 patients treated between 2003 and 2013. A total of 56 patients underwent two-stage hepatectomy for initially nonresectable colorectal liver metastases. Chemotherapy was combined with a biotherapy in 32 cases. The tumor regression grade, modified tumor regression grade, and Blazer grade were used to classify patients as responders (tumor regression grade and modified tumor regression grade 1-3, Blazer 0-1) or nonresponders (tumor regression grade and modified tumor regression grade 4-5, Blazer 2) after the first stage. Tumor response in the three classifications was associated with second-stage completion (tumor regression grade 1-3: OR = 4.01, 95% CI: 1.12-14.36, P = .033; modified tumor regression grade 1-3: OR = 3.8, 95%CI: 1.13-12.6, P = .03; Blazer 0-1: OR = 5.45, 95% CI: 1.66-17.85, P = .005). Triple chemotherapy was also associated with responders. The median overall survival of responders was significantly higher (Blazer 0-1: 42.9 months versus Blazer 2: 20.1 months, P = .018; tumor regression grade 1-3: 42.9 months versus tumor regression grade 4-5: 25.1 months, P = .04). A pathologic response to chemotherapy is associated with second-stage completion and longer survival. Further studies are needed to achieve the early identification of patients for whom the benefit of the second surgical stage is less straightforward.

The Relationship Between Postoperative Chemotherapy and Remnant Liver Regeneration and Outcomes After Hepatectomy for Colorectal Liver Metastasis

BackgroundPostoperative chemotherapy for treating colorectal liver metastasis (CLM) has been introduced with the aim of improving therapeutic outcomes. However, there is no consensus on the utility of multidisciplinary treatments with postoperative chemotherapy. Therefore, we evaluated surgical outcomes in patients with CLMs who underwent hepatectomy, while focusing on the effects of post-hepatectomy chemotherapy on remnant liver regeneration. MethodsTwo hundred ninety patients who underwent hepatectomy were retrospectively analyzed using propensity score matching. Postoperative outcomes were evaluated with a focus on the effects of post-hepatectomy chemotherapy on regeneration of the remnant liver in patients with CLM. The remnant liver volumes (RLVs) were measured postoperatively using multi-detector computed tomography on day 7 and months 1, 2, 5, and 12 after the operation. ResultsRLV regeneration and postoperative blood laboratory data did not differ significantly between patients who received postoperative chemotherapy and those who did not receive postoperative chemotherapy immediately after surgery or at any time point from postoperative day 7 to postoperative month 12. The recurrence rates, including same and other segmental intrahepatic recurrences, as well as the resection frequency of the remnant liver were not significantly different between the two groups. ConclusionPostoperative chemotherapy may be of small significance for patients with CLM in terms of the remnant liver volume regeneration and functional recovery.