Surgery to remove colon or rectal cancer that has spread to the liver can sometimes cure the cancer. However, the cancer can return again to the liver. If it does, a second surgical liver resection can be effective in producing 5-year survivals.
Reviewing 111 second hepatectomies done in a Tokyo cancer center from 1985 through 2004, researchers found that overall 41% of patients lived at least five years after surgery. They identified the following risk factors that led to poorer survival.
- Presence of liver mets at the time that the primary tumor in colon or rectum was surgically removed. (synchronous liver and primary cancers)
- More than three liver mets at the time of the second liver resection.
- Cancer involved with the hepatic vein and/or the portal vein at the time of first resection.
Five-year survival after the second liver resection depended on the number of those risk factors present.
- No risk factors — 62%
- One risk factor — 38%
- Two risk factors — 19%
- Three factors — 0%
Seiji Ishiguro and colleagues at the National Cancer Center Hospital in Tokyo, Japan concluded:
Second hepatectomy is beneficial for patients without any risk factors. Before second hepatectomy, chemotherapy should be considered for patients with any of these risk factors, especially with two or three factors, in the adjuvant or neoadjuvant setting to prolong survival. These results need to be confirmed and validated in another data set or future prospective trial according to the scoring scheme we outline.
WHAT THIS MEANS FOR PATIENTS
This is a study done in a single hospital over a fairly long period of time. Information about chemotherapy before or after liver resection is not included.
If your liver mets have returned, you should consider whether the pain and risk of surgery is worthwhile in light of the risk factors outlined above, but you should also work with a multidisciplinary team of surgeons, oncologists, and radiologists to decide the best treatment.
In some situations second liver resections are not only possible but they lead to excellent outcomes.
No risk factors or one factor might mean that surgery would give you a good chance of 5-year survival.
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