Title: Recurred colorectal liver metastasis following initial hepatectomy: is repeat hepatectomy justified?
Abstract: Liver resection is considered the only curative treatment modality for colorectal liver metastasis (CRLM). Recurrence rate after hepatectomy, however, has been reported over 50 % of patients. Second or more hepatectomies are applied to treat recurred metastases. The aim of this study is to assess efficiency and feasibility of repeat hepatectomy and to analyze prognostic factors after repeat hepatectomy. Two hundred forty-eight patients were diagnosed as recurred CRLM between January 2003 and May 2016: Second hepatectomy and third hepatectomy were performed in 70 patients and 7 patients, respectively. The other 171 patients did not undergo repeat hepatectomy. Clinical features were collected from medical records. We compared overall survivals of repeat hepatectomy group and non-repeat hepatectomy group. We also investigated factors affecting overall and disease-free survivals of patients who received repeat hepatectomy using univariate and multivariate analyses. Overall survival was significantly higher in repeat hepatectomy group than that of non-repeat hepatectomy group (p< 0.01). The morbidity and mortality rates of second hepatectomy were 9.09 % and 0 %, and 3-year and 5-year survival rates were 61.7 % and 50.1 %, respectively. The rates of morbidity and mortality of third hepatectomy were 28.6 % and 0 %, respectively. Number of hepatectomy was only significant in disease-free survival (p< 0.01). There were no factors influencing overall survival. Repeat hepatectomy can be necessary, effective and safe for treating recurred CRLM. Number of hepatectomy was significant factor affecting disease-free survival.