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Role of Repeat Resection in Patients With Metastatic Colorectal Cancer

A Multicenter Retrospective Study

Matsumoto, Takuya, M.D., Ph.D.1; Hasegawa, Suguru, M.D., Ph.D.2; Hida, Koya, M.D., Ph.D.3; Kawada, Kenji, M.D., Ph.D.3; Sakai, Yoshiharu, M.D., Ph.D.3; Sugihara, Kenichi, M.D., Ph.D.4

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 561–567
doi: 10.1097/DCR.0000000000001311
Original Contribution: Colorectal Cancer
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BACKGROUND: Little is known about repeat resection for recurrence exclusive of the liver and lungs and the natural history after the first curative resection in patients with metastatic colorectal cancer.

OBJECTIVE: This study aimed to investigate the role of repeat resection for recurrence of metastatic colorectal cancer in a Japanese cohort.

DESIGN: This is a multi-institution retrospective observational study.

SETTING: This study was conducted at participating tertiary referral hospitals.

PATIENTS: Patients with metastatic colorectal cancer who had synchronous distant metastases and underwent simultaneous resection of primary and distant disease or sequential staged resection at short intervals between 1997 and 2007 were included.

MAIN OUTCOME MEASURES: The primary outcomes measured were patterns of recurrence site, treatments, and survival.

RESULTS: A total of 1133 patients were identified, of whom 1073 were eligible. In total, 809 of the 1073 patients developed recurrence after curative resection, and 323 of these underwent repeat resection for recurrence. Of these, 211 developed re-recurrence; 80 of these patients underwent a second repeat resection. When stratified by site of recurrence, the 5-year overall survival rate in patients who underwent repeat resection was 56% in those with recurrence in the liver only, 43% in those with recurrence in the lung only, 30% in those with peritoneal seeding only, and 28% in those with multiple organ involvement. In patients who underwent a second repeat resection, the 5-year overall survival rates were 56%, 46%, 100%, and 50%.

LIMITATIONS: This study was limited by its retrospective study design.

CONCLUSIONS: Repeat surgery could have long-term survival benefit in patients with metastatic colorectal cancer who develop recurrence or re-recurrence in the liver or lung following curative resection. However, repeat surgery should be considered carefully in patients with peritoneal seeding only or recurrence at multiple sites. See Video Abstract at http://links.lww.com/DCR/A838.

1 Department of Gastrointestinal Surgery, Himeji Medical Center, Hyogo, Japan

2 Department of Surgery, Fukuoka University Hospital, Fukuoka, Japan

3 Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

4 Tokyo Medical and Dental University, Tokyo, Japan

Funding/Support: None reported.

Financial Disclosures: None reported.

Presented at the meeting of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer (JFUP-CRC), Tokyo, Japan, January 25, 2014.

Correspondence: Takuya Matsumoto, M.D., Ph.D., Department of Gastrointestinal Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo 670-8520, Japan. E-mail: takmatsu@kuhp.kyoto-u.ac.jp

© 2019 The American Society of Colon and Rectal Surgeons