Surgical strategy for repeated metastasectomy for advanced colorectal cancer with synchronous liver metastases.

Purpose: Liver metastases from colorectal cancer (CRLM) are a major determinant of the prognosis of metastatic colorectal cancer. Although curative resection is recommended for resectable CRLM, recurrence remains a challenge and the criteria for patient selection and repeat resection are still unclear. We conducted this study to evaluate the outcomes of metastatic lesion resection with curative intent (R0 resection), to identify the factors associated with recurrence, and to establish the feasibility of repeat metastasectomy.

Methods: This single-center retrospective study analyzed 135 patients with synchronous CRLM, who underwent surgical resection or received chemotherapy between January, 2013 and March, 2023.

Results: R0 resection was achieved in 62 (45.9%), with a median recurrence-free survival of 12.3 months. Recurrence developed in 50 (80.6%) of these patients and 28 underwent repeat R0 resection. Initial R0 resection was associated with significantly improved overall survival (OS; hazard ratio [HR], 0.12; p < 0.01) and repeat R0 resection after recurrence improved survival further (HR, 0.32; p = 0.019). Conversion surgery, performed in 42 of 114 patients (36.8%) initially treated with chemotherapy, was significantly associated with the absence of extrahepatic metastases and H1 liver metastases.

Conclusions: These findings highlight the importance of individualized treatment strategies for optimizing CRLM outcomes.