Clinical

Pelvic recurrence common after hepatic resection of rectal metastases

Last Updated: 2008-09-05 17:51:38 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Pelvic recurrence is common after resection of hepatic metastases from rectal carcinoma, according to a report in the August Archives of Surgery.

"In the current study, the high rate of pelvic recurrence following hepatic resection of liver metastases in patients with a rectal primary has important implications, as it serves to emphasize that adequate therapy of both pelvic and hepatic disease is important and that close surveillance of the pelvis is necessary following resection of rectal liver metastases," Dr. Timothy M. Pawlik from The Johns Hopkins School of Medicine, Baltimore, told Reuters Health.

Dr. Pawlik and colleagues sought to determine how the primary rectal tumor site and the pattern of recurrence affected disease-free and overall survival rates following hepatic metastectomy.

The actuarial disease-free survival was 68.4% at 1 year, 34.5% at 3 years, and 32.9% at 5 years, and was the same for colon and rectal primaries.

Median disease-free survival was best among patients who had a complete primary tumor pathological response following neoadjuvant rectal chemoradiation therapy, the investigators say. Greater tumor size, positive margin status, and a history of radiofrequency ablation were associated with shorter disease-free survival.

Overall survival following hepatic metastectomy was 36.4% at 5 years.

Median survival time was significantly greater for patients who eventually developed recurrence at only one disease site (39.9 months) than for patients who developed recurrence at multiple anatomic sites (26.6 months), though the location of the recurrence did not seem to influence survival.

Twenty-three patients who underwent a repeat metastectomy with curative intent had 3- and 5-year survival rates after repeat liver resection of 76.7% and 38.6%, respectively.

These rates are "not dissimilar to the 3- and 5-year overall survival rates following initial metastectomy," Dr. Pawlik said. "Our data, therefore, support the use of judicious re-resection of locoregional and metastatic disease."

"Surgery for recurrent disease following hepatic resection of rectal liver metastasis should be strongly considered as long-term survival can be achieved in well-selected patients," Dr. Pawlik concluded.

Arch Surg 2008;143:743-749.