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  • br The second and third recurrences were

    2022-07-06


    The second and third recurrences were treated under the same indications as the first recurrence. All operations were performed by specialized colorectal, hepatobiliary, and thoracic surgeons. The presence of extrahepatic or extrapulmonary metastases was considered as a contrain-dication for repeated resection. However, in patients with a solitary metastasis or metastasis that was limited to an organ, such as the primary (colorectal) local site, ovaries, local Tubercidin nodes, celiac lymph nodes, para-aortic lymph nodes, adrenal glands, or peritoneum, with or without intrahepatic and/or pulmonary recurrence, we performed a repeated resection. In principle, radiofrequency ablation (RFA) for liver metastases and stereotactic radiosurgery for pulmonary metastases were not performed in patients with resectable metastasis, except for patients with a high-risk surgery or insufficient remnant liver or lung volume. After the repeated resection, postoperative chemotherapy was recommended, except for patients with poor performance or older age.
    The median follow-up duration was 66 months (range, 6e94 months). The following patient characteristics were analyzed: age, sex, primary tumor location, pathologic TNM stage, presence of lymphovascular invasion and/or peri-neural invasion, histologic differentiation, and metastasis type. After the first metastasectomy, 74% of the patients underwent postoperative chemotherapy (Table 1).
    After metastasectomy, patients were routinely followed up every 3 months, and the levels of serum carcinoem-bryonic antigen (CEA) were measured at every follow-up visit. Surveillance imaging, including abdominopelvic and chest computed tomography scans, was performed every 3 months, during the first 2 years of follow-up, and every 6 months thereafter, until the disease-free interval exceeded 5 years.
    The OS rate after the first metastasectomy for the first recurrence was defined as the interval from the date of the first metastasectomy to any-cause mortality or the date of the last follow-up (Fig. 1). The recurrence-free survival (RFS) after the surgical resection for the initial recurrence (RFS1) was defined as the interval from the date of the first metastasectomy to the recurrence from colorectal cancer or all-cause mortality, whichever occurred first. The RFS after the first (RFS2) and second (RFS3) repeated resections was defined as the time from the date of the first and second repeat surgeries, respec-tively. The primary endpoints for primary structure study were survival and clinical recurrence.
    This study protocol was approved by the institutional review board of the Asan Medical Center (registration no:
    Please cite this article as: Yang KM et al., Benefits of repeated resections for liver and lung metastases from colorectal cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.03.002
    + MODEL
    Repeat metastasectomy from colorectal cancer 3
    Table 1 Demographic and clinical characteristics of thepatients undergoing 1st metastasectomy.
    Variable
    Patient characteristics
    Primary tumor characteristics
    Location of the primary tumor
    T Stage
    N Stage
    Stage
    invasion
    Differentiation
    Type of metastasis
    yes
    XELOX, capecitabine-oxaliplatin; FOLFOX, folinic acid-
    efluorouracileoxaliplatin; FOLFIRI, folinic
    acidefluorouracileirinotecan.
    2.2. Statistical analysis
    Survival curves were generated using the KaplaneMeier method, and the differences between curves were evalu-ated using the log-rank test. With regard to comparison of the RFS, patients who underwent first, second, and third metastasectomy were considered as the independent groups eligible for the analysis. Multivariate analyses for survival included the variables that showed statistical sig-nificance in the log-rank test and were performed using the Cox proportional hazards model, with a 95% confidence interval (CI), to assess the risk factors associated with overall survival. Statistical significance was defined as p < 0.05, and all analyses were performed using the SPSS software version 21 (IBM Corp., Armonk, NY).