Repeat Hepatectomy for Recurrent Colorectal Liver Metastases

Abstract

Introduction: After initial hepatectomy for colorectal liver metastases, liver recurrence occurs in the majority of patients. Repeat hepatectomy has become an accepted treatment. This review examines outcomes of repeated hepatectomy and the factors predicting successful salvage.

Methods: A systematic review identified studies reporting outcomes of second and third hepatectomies. Primary outcomes were overall survival after repeat resection and perioperative mortality. Predictors of survival including disease-free interval, number of metastases, and carcinoembryonic antigen level were analyzed.

Results: Twenty-one series (totaling over three thousand repeat hepatectomies) were reviewed. Five-year survival after repeat hepatectomy ranged from thirty to forty percent, comparable to first hepatectomy. Perioperative mortality was under five percent. A disease-free interval longer than twelve months and a single recurrent nodule were favorable predictors. Third hepatectomy showed diminishing but still meaningful survival benefit.

Discussion: Repeat hepatectomy is feasible and offers long-term survival in selected patients. The surgical approach may be more challenging due to adhesions and altered liver anatomy. Parenchyma-sparing techniques are especially important after previous resections. Ablative therapies or stereotactic radiotherapy are alternatives for non-surgical candidates.

Conclusions: Repeat hepatectomy should be considered the standard of care for patients with resectable recurrent colorectal liver metastases, providing outcomes comparable to first resection. Strict selection criteria optimize benefit.