Outcomes after Repeat Hepatectomy for Recurrent Colorectal Liver Metastases: Results from the Colorectal Liver Operative Metastasis International Collaborative

Introduction: Resection of colorectal metastases to the liver has become the standard of care when feasible, prolonging survival. However, despite improved surgical approaches, subsequent isolated hepatic recurrences are not unusual. Repeat hepatectomy for Colorectal Liver Metastases (CLM) appears to be safe and effective for recurrent disease, but there is paucity of outcomes data with few reports from large studies. Methods: An international collaborative of five institutions (Wake Forest, Mayo Clinic Jacksonville, University of California San Francisco, Yale, and University of Hong Kong) have collected approximately one thousand CLM cases performed at these locations from 2000-2018. Compiled data included patient demographics and tumor characteristics, recurrences , and overall survival. Kaplan-Meier analysis was performed with the Log Rank test to determine differences between subgroups. Results: Repeat hepatectomy was performed in 51 (23.4%) ouf of 218 patients who had isolated hepatic recurrences. From time of initial hepatectomy, there was significantly improved median overall survival compared to those who received one hepatectomy (61.0 vs 38.3 months, p<0.01). The same held true for median overall survival from the time of diagnosis (74.0 vs. 57.5 months for two versus one hepatectomy; p<0.05). Median disease-free survival was significantly longer for patients who received a repeat versus single hepatectomy (12.4 vs. 10.5 months; p<0.05). Conclusion: A second hepatectomy was beneficial for patients with recurrent CLM, yielding improved median overall survival and disease-free survival compared to those who received one hepatectomy. Although retrospective, our data suggest second hepatectomy for isolated liver recurrence can be beneficial, when clinically feasible.