Background

Liver resection for colorectal metastases is affected by a non-negligible recurrence rate. The earlier the recurrence, the worse the prognosis. We analyzed an unexplored topic, i.e., the incidence, predictive factors, and prognostic impact of very early recurrence (≤ 3 months after hepatectomy).

Methods

All consecutive liver resections for colorectal metastases performed between 2004 and 2017 were retrospectively reviewed. Inclusion criteria were available recurrence status at 3 months after resection and follow-up ≥ 12 months.

Results

Overall, 484 patients were analyzed; 56 (11.6%) had very early recurrence. Independent predictors were number of metastases (very early recurrence in 3.7% of patients with solitary metastasis, 8.1% of those with 2–9 metastases; 20.0% of those with 10–14 metastases; 44.4% of those with ≥ 15 metastases, p < 0.001) and extrahepatic disease (very early recurrence in 23.2% of patients with vs. 10.1% of those without extrahepatic disease, p = 0.017). Very early recurrence rate in patients with ≥ 15 metastases and simultaneous extrahepatic disease was 71.4%. Patients with very early recurrence had poor survival (5-year survival 17.3% vs. 44.5% of non-very early recurrence patients, p < 0.001), worse than patients with 3-to-6 months recurrence (p = 0.070), and no different from unresected patients (p = 0.114). Fifteen patients with very early recurrence (26.8%) underwent repeated treatment with adequate survival (at 3 years 42.2%), but seven had a further recurrence within 3 months.

Conclusions

Very early recurrence occurs in about 12% of patients undergoing aggressive surgery for colorectal metastases. The risk is increased in patients with numerous metastases or extrahepatic disease. Very early recurrence is associated with very poor prognosis, similar to that of unresected patients, and a low chance of effective repeated treatment.

中文翻译：

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结直肠转移瘤肝切除术后极早复发：发生率、危险因素和预后影响

背景

结直肠转移瘤的肝切除术受到不可忽视的复发率的影响。复发越早，预后越差。我们分析了一个未探索的主题，即极早期复发（肝切除术后≤ 3 个月）的发生率、预测因素和预后影响。

方法

回顾性回顾了 2004 年至 2017 年间进行的所有结直肠转移肝切除术。纳入标准为切除后 3 个月的可用复发状态和随访 ≥ 12 个月。

结果

总共分析了 484 名患者；56 (11.6%) 有很早的复发。独立预测因素是转移的数量（3.7% 的孤立转移患者极早复发，2-9 个转移患者的 8.1%；10-14 个转移患者的 20.0%；≥ 15 个转移患者的 44.4%，p  < 0.001) 和肝外疾病（23.2% 的患者与没有肝外疾病的患者相比，10.1% 的患者极早复发，p  = 0.017）。≥ 15 个转移灶且同时存在肝外疾病的患者的极早期复发率为 71.4%。极早期复发患者的生存率较差（5 年生存率 17.3% 与非极早期复发患者的 44.5%，p  < 0.001），比 3 至 6 个月复发的患者更差（p = 0.070），与未切除的患者没有区别（p  = 0.114）。15 名极早期复发患者 (26.8%) 接受重复治疗并获得足够的生存期 (3 年 42.2%)，但 7 名患者在 3 个月内再次复发。

结论

大约 12% 的结直肠转移瘤患者在接受积极手术后会出现极早期复发。有许多转移灶或肝外疾病的患者风险增加。极早复发与预后极差有关，类似于未切除的患者，并且有效重复治疗的机会很低。