TY - JOUR
T1 - Determinants of Repeat Curative Intent Surgery in Colorectal Liver Metastasis
AU - Kulaylat, Afif N.
AU - Bhayani, Neil H.
AU - Stokes, Audrey L.
AU - Schubart, Jane R.
AU - Wong, Joyce
AU - Kimchi, Eric T.
AU - Staveley-O’Carroll, Kevin F.
AU - Kaifi, Jussuf T.
AU - Gusani, Niraj J.
N1 - Publisher Copyright:
© 2014, The Society for Surgery of the Alimentary Tract.
PY - 2014/11
Y1 - 2014/11
N2 - Introduction: Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported. Methods: An institutional database (January 2002–December 2012) was reviewed to evaluate factors influencing repeat CIS. Results: One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63 %) recurred. Fifty-three patients (52 %) underwent a repeat CIS. After repeat CIS, 33 patients (62 %) developed a second recurrence, and in 13 patients (39 %), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p < 0.001). Overall 5-year survival in all patients was 55 %; patients who recurred had a 5-year survival of 67 % if they underwent repeat CIS vs. 7.8 % if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months. Conclusion: Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
AB - Introduction: Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported. Methods: An institutional database (January 2002–December 2012) was reviewed to evaluate factors influencing repeat CIS. Results: One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63 %) recurred. Fifty-three patients (52 %) underwent a repeat CIS. After repeat CIS, 33 patients (62 %) developed a second recurrence, and in 13 patients (39 %), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p < 0.001). Overall 5-year survival in all patients was 55 %; patients who recurred had a 5-year survival of 67 % if they underwent repeat CIS vs. 7.8 % if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months. Conclusion: Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
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U2 - 10.1007/s11605-014-2580-7
DO - 10.1007/s11605-014-2580-7
M3 - Article
C2 - 24950776
AN - SCOPUS:84933515927
SN - 1091-255X
VL - 18
SP - 1894
EP - 1901
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -