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Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival
PURPOSE: Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60 % of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a con...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712136/ https://www.ncbi.nlm.nih.gov/pubmed/23371333 http://dx.doi.org/10.1007/s00384-013-1648-2 |
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author | Homayounfar, K. Bleckmann, A. Conradi, L. C. Sprenger, T. Lorf, T. Niessner, M. Sahlmann, C. O. Meller, J. Liersch, T. Ghadimi, B. M. |
author_facet | Homayounfar, K. Bleckmann, A. Conradi, L. C. Sprenger, T. Lorf, T. Niessner, M. Sahlmann, C. O. Meller, J. Liersch, T. Ghadimi, B. M. |
author_sort | Homayounfar, K. |
collection | PubMed |
description | PURPOSE: Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60 % of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a consecutive series of patients with SMR. METHODS: From 01/2001 to 11/2011, 104 out of 178 consecutive patients with R0-resection of CRC-LM developed SMR and were evaluated. The impact of surgical and Ctx re-interventions on recurrence free (RFS) and cancer-specific survival (CSS) was analyzed. Median follow-up was 28.0 (95 %CI: 19.4–37.4) months. RESULTS: SMR occurred in 81 patients at a single site (49× liver, 18× lung, 14× other) and in 23 patients at multiple sites. Forty-two patients were scheduled for primary surgery. Fifty-three patients were classified as non-resectable and treated with median 5.0 [IQR, 3.0–10.0] cycles of Ctx, combined with an EGFR/VEGF-antibody in 27 patients. Nine patients received best supportive care only. R0/R1 resection could be achieved in 35 patients primarily and even in 8 patients secondarily after Ctx. Surgical morbidity and mortality were 16 and 0 %, respectively. The 5-year RFS rates for patients with R0 versus R1-resection were 22 and 24 % (p = 0.948). The 5-year CSS rate for R0/R1-resected patients was 38 % versus 10 % for those patients treated by Ctx alone (p < 0.001). CONCLUSION: In SMR, surgical re-intervention is feasible and safe in a remarkable number of patients and offers significantly longer CSS compared to patients without resection. |
format | Online Article Text |
id | pubmed-3712136 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-37121362013-07-18 Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival Homayounfar, K. Bleckmann, A. Conradi, L. C. Sprenger, T. Lorf, T. Niessner, M. Sahlmann, C. O. Meller, J. Liersch, T. Ghadimi, B. M. Int J Colorectal Dis Original Article PURPOSE: Surgery is the standard of care for resectable colorectal liver metastases (CRC-LM). Unfortunately, 60 % of patients develop secondary metastatic recurrence (SMR) after R0-resection of CRC-LM. We investigated the impact of surgical re-intervention and chemotherapy (Ctx) on survival in a consecutive series of patients with SMR. METHODS: From 01/2001 to 11/2011, 104 out of 178 consecutive patients with R0-resection of CRC-LM developed SMR and were evaluated. The impact of surgical and Ctx re-interventions on recurrence free (RFS) and cancer-specific survival (CSS) was analyzed. Median follow-up was 28.0 (95 %CI: 19.4–37.4) months. RESULTS: SMR occurred in 81 patients at a single site (49× liver, 18× lung, 14× other) and in 23 patients at multiple sites. Forty-two patients were scheduled for primary surgery. Fifty-three patients were classified as non-resectable and treated with median 5.0 [IQR, 3.0–10.0] cycles of Ctx, combined with an EGFR/VEGF-antibody in 27 patients. Nine patients received best supportive care only. R0/R1 resection could be achieved in 35 patients primarily and even in 8 patients secondarily after Ctx. Surgical morbidity and mortality were 16 and 0 %, respectively. The 5-year RFS rates for patients with R0 versus R1-resection were 22 and 24 % (p = 0.948). The 5-year CSS rate for R0/R1-resected patients was 38 % versus 10 % for those patients treated by Ctx alone (p < 0.001). CONCLUSION: In SMR, surgical re-intervention is feasible and safe in a remarkable number of patients and offers significantly longer CSS compared to patients without resection. Springer Berlin Heidelberg 2013-02-01 2013 /pmc/articles/PMC3712136/ /pubmed/23371333 http://dx.doi.org/10.1007/s00384-013-1648-2 Text en © The Author(s) 2013 https://creativecommons.org/licenses/by-nc/2.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Original Article Homayounfar, K. Bleckmann, A. Conradi, L. C. Sprenger, T. Lorf, T. Niessner, M. Sahlmann, C. O. Meller, J. Liersch, T. Ghadimi, B. M. Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title | Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title_full | Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title_fullStr | Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title_full_unstemmed | Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title_short | Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
title_sort | metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712136/ https://www.ncbi.nlm.nih.gov/pubmed/23371333 http://dx.doi.org/10.1007/s00384-013-1648-2 |
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