Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases
Objective This 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). Background More than half of all patients who receive a curative initial hepatectomy for CLM dev...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2020-02, Vol.24 (2), p.380-387 |
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| creator | Takamoto, Takeshi Hashimoto, Takuya Miyata, Akinori Shimada, Kei Maruyama, Yoshikazu Makuuchi, Masatoshi |
| description | Objective
This 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).
Background
More 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.
Methods
Data 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.
Results
After 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
|
| doi_str_mv | 10.1007/s11605-019-04154-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2187956958</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2187708721</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-1dae7a9e249606f6e2b60ac75efd64efacb26795f08059f0fa47ca7933159c263</originalsourceid><addsrcrecordid>eNp9kEFLwzAUx4Mobk6_gAcpePESfUmbpDmOoU6ZCKLgLWTdi2x0a01aYd_ebJ2KHoTAy3v55Z_wI-SUwSUDUFeBMQmCAtMUMiYymu-RPstVSjPJ5X7cg2aUC_HaI0chLACYApYfkl4KeQqCiT65f8IabZOMsbYNFk21XCdD16BPHuyi8r_mLvajqqx87G2ZTOYfGwwbG-LCcEwOnC0DnuzqgLzcXD-PxnTyeHs3Gk5okSrRUDazqKxGnmkJ0knkUwm2UALdTGbobDHlUmnhIAehHTibqcIqnaZM6ILLdEAuutzaV-8thsYs56HAsrQrrNpgeFSghdQij-j5H3RRtX4Vf7elFOSKs0jxjip8FYJHZ2o_X1q_NgzMxrTpTJto2mxNm0302S66nS5x9n3lS20E0g4I8Wj1hv7n7X9iPwGgyohO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2187708721</pqid></control><display><type>article</type><title>Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Takamoto, Takeshi ; Hashimoto, Takuya ; Miyata, Akinori ; Shimada, Kei ; Maruyama, Yoshikazu ; Makuuchi, Masatoshi</creator><creatorcontrib>Takamoto, Takeshi ; Hashimoto, Takuya ; Miyata, Akinori ; Shimada, Kei ; Maruyama, Yoshikazu ; Makuuchi, Masatoshi</creatorcontrib><description>Objective
This 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).
Background
More 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.
Methods
Data 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.
Results
After 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).
Conclusions
The 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.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-019-04154-8</identifier><identifier>PMID: 30830515</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cancer surgery ; Colorectal Neoplasms - pathology ; Feasibility Studies ; Female ; Gastroenterology ; Gastrointestinal surgery ; Hepatectomy ; Hepatectomy - adverse effects ; Hepatectomy - methods ; Humans ; Liver ; Liver cancer ; Liver Neoplasms - pathology ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Medicine ; Medicine & Public Health ; Metastasis ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Original Article ; Reoperation ; Retrospective Studies ; Surgery ; Survival Rate ; Tumor Burden</subject><ispartof>Journal of gastrointestinal surgery, 2020-02, Vol.24 (2), p.380-387</ispartof><rights>The Society for Surgery of the Alimentary Tract 2019</rights><rights>Journal of Gastrointestinal Surgery is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-1dae7a9e249606f6e2b60ac75efd64efacb26795f08059f0fa47ca7933159c263</citedby><cites>FETCH-LOGICAL-c375t-1dae7a9e249606f6e2b60ac75efd64efacb26795f08059f0fa47ca7933159c263</cites><orcidid>0000-0003-0455-6412</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-019-04154-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-019-04154-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30830515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takamoto, Takeshi</creatorcontrib><creatorcontrib>Hashimoto, Takuya</creatorcontrib><creatorcontrib>Miyata, Akinori</creatorcontrib><creatorcontrib>Shimada, Kei</creatorcontrib><creatorcontrib>Maruyama, Yoshikazu</creatorcontrib><creatorcontrib>Makuuchi, Masatoshi</creatorcontrib><title>Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Objective
This 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).
Background
More 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.
Methods
Data 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.
Results
After 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).
Conclusions
The 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer surgery</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Hepatectomy</subject><subject>Hepatectomy - adverse effects</subject><subject>Hepatectomy - methods</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Original Article</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Tumor Burden</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kEFLwzAUx4Mobk6_gAcpePESfUmbpDmOoU6ZCKLgLWTdi2x0a01aYd_ebJ2KHoTAy3v55Z_wI-SUwSUDUFeBMQmCAtMUMiYymu-RPstVSjPJ5X7cg2aUC_HaI0chLACYApYfkl4KeQqCiT65f8IabZOMsbYNFk21XCdD16BPHuyi8r_mLvajqqx87G2ZTOYfGwwbG-LCcEwOnC0DnuzqgLzcXD-PxnTyeHs3Gk5okSrRUDazqKxGnmkJ0knkUwm2UALdTGbobDHlUmnhIAehHTibqcIqnaZM6ILLdEAuutzaV-8thsYs56HAsrQrrNpgeFSghdQij-j5H3RRtX4Vf7elFOSKs0jxjip8FYJHZ2o_X1q_NgzMxrTpTJto2mxNm0302S66nS5x9n3lS20E0g4I8Wj1hv7n7X9iPwGgyohO</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Takamoto, Takeshi</creator><creator>Hashimoto, Takuya</creator><creator>Miyata, Akinori</creator><creator>Shimada, Kei</creator><creator>Maruyama, Yoshikazu</creator><creator>Makuuchi, Masatoshi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0455-6412</orcidid></search><sort><creationdate>20200201</creationdate><title>Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases</title><author>Takamoto, Takeshi ; Hashimoto, Takuya ; Miyata, Akinori ; Shimada, Kei ; Maruyama, Yoshikazu ; Makuuchi, Masatoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-1dae7a9e249606f6e2b60ac75efd64efacb26795f08059f0fa47ca7933159c263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer surgery</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Hepatectomy</topic><topic>Hepatectomy - adverse effects</topic><topic>Hepatectomy - methods</topic><topic>Humans</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Original Article</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takamoto, Takeshi</creatorcontrib><creatorcontrib>Hashimoto, Takuya</creatorcontrib><creatorcontrib>Miyata, Akinori</creatorcontrib><creatorcontrib>Shimada, Kei</creatorcontrib><creatorcontrib>Maruyama, Yoshikazu</creatorcontrib><creatorcontrib>Makuuchi, Masatoshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takamoto, Takeshi</au><au>Hashimoto, Takuya</au><au>Miyata, Akinori</au><au>Shimada, Kei</au><au>Maruyama, Yoshikazu</au><au>Makuuchi, Masatoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>24</volume><issue>2</issue><spage>380</spage><epage>387</epage><pages>380-387</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Objective
This 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).
Background
More 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.
Methods
Data 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.
Results
After 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).
Conclusions
The 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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30830515</pmid><doi>10.1007/s11605-019-04154-8</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0455-6412</orcidid></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2020-02, Vol.24 (2), p.380-387 |
| issn | 1091-255X 1873-4626 |
| language | eng |
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| subjects | Adult Aged Aged, 80 and over Cancer surgery Colorectal Neoplasms - pathology Feasibility Studies Female Gastroenterology Gastrointestinal surgery Hepatectomy Hepatectomy - adverse effects Hepatectomy - methods Humans Liver Liver cancer Liver Neoplasms - pathology Liver Neoplasms - secondary Liver Neoplasms - surgery Male Medicine Medicine & Public Health Metastasis Middle Aged Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Original Article Reoperation Retrospective Studies Surgery Survival Rate Tumor Burden |
| title | Repeat Hepatectomy After Major Hepatectomy for Colorectal Liver Metastases |
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