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Very Early Recurrence After Liver Resection for Colorectal Metastases: Incidence, Risk Factors, and Prognostic Impact

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56 20089, Rozzano, Milan, Italy

    Luca Viganò, Damiano Gentile, Jacopo Galvanin, Pio Corleone, Guido Costa, Matteo Cimino, Fabio Procopio & Guido Torzilli

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 20072, Pieve Emanuele, Milan, Italy

    Luca Viganò & Guido Torzilli

Authors
  1. Luca Viganò
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  2. Damiano Gentile
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  3. Jacopo Galvanin
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  4. Pio Corleone
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  5. Guido Costa
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  6. Matteo Cimino
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  7. Fabio Procopio
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  8. Guido Torzilli
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Correspondence to Guido Torzilli.

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Ethics Approval and Consent to Participate

The present study complied with the guidelines for human studies. The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Institutional Review Board of our hospital approved this retrospective study. Each patient provided informed consent for operation and clinical data acquisition.

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The authors declare no competing interests.

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Viganò, L., Gentile, D., Galvanin, J. et al. Very Early Recurrence After Liver Resection for Colorectal Metastases: Incidence, Risk Factors, and Prognostic Impact. J Gastrointest Surg 26, 570–582 (2022). https://doi.org/10.1007/s11605-021-05123-w

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