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Rates and Patterns of Recurrence Following Curative Intent Surgery for Colorectal Liver Metastasis: An International Multi-Institutional Analysis of 1669 Patients

de Jong, Mechteld C. MD*; Pulitano, Carlo MD†; Ribero, Dario MD‡; Strub, Jennifer MD§; Mentha, Gilles MD§; Schulick, Richard D. MD*; Choti, Michael A. MD*; Aldrighetti, Luca MD, PhD†; Capussotti, Lorenzo MD‡; Pawlik, Timothy M. MD, MPH*

doi: 10.1097/SLA.0b013e3181b4539b
Original Articles

Objective(s): To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis.

Background: Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited.

Methods: One thousand six hundred sixty-nine patients treated with surgery (resection ± radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed.

Results: At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra- and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra- and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease.

Conclusions: While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra- plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.

Patients with colorectal liver metastasis now have much longer overall survival following curative intent surgery. Information on rates and patterns of recurrence is limited. Data from the current study demonstrate that while 5-year survival following curative intent surgery for colorectal liver metastasis approaches 50%, over one-half of patients will develop recurrence within 2 years.

From the *Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Surgery, Ospedale San Raffaele, Milan, Italy; ‡Department of Surgery, Ospedale Mauriziano Umberto I, Turin, Italy; §Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.

Supported by the National Center for Research Resources (NCRR) grant (1KL2RR025006-01), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research (to T.M.P).

Presented April 24th, 2009 at the Annual Meeting of the American Surgical Association Meeting, Indian Wells, CA.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Reprints: Timothy M. Pawlik, MD, MPH, Department of Surgery, Johns Hopkins University School of Medicine, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287. E-mail: tpawlik1@jhmi.edu.

© 2009 Lippincott Williams & Wilkins, Inc.