Recurrence After Liver Resection of Colorectal Liver Metastases: Repeat Resection or Ablation Followed by Hepatic Arterial Infusion Pump Chemotherapy

Florian E Buisman*, Wills F Filipe, Nancy E Kemeny, Raja R Narayan, Rami M Srouji, Vinod P Balachandran, Thomas Boerner, Jeffrey A Drebin, William R Jarnagin, T Peter Kingham, Alice C Wei, Dirk J Grünhagen, Cornelis Verhoef, Bas Groot Koerkamp, Michael I D'Angelica

*Corresponding author for this work

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Abstract

BACKGROUND: The aim of this study was to investigate the effectiveness of adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after complete resection or ablation of recurrent colorectal liver metastases (CRLM).

METHODS: A retrospective cohort study was conducted of patients from two centers who were treated with resection and/or ablation of recurrent CRLM only between 1992 and 2018. Overall survival (OS) and hepatic disease-free survival (hDFS) were estimated using the Kaplan-Meier method. The Cox regression method was used to calculate hazard ratios (HRs) with corresponding 95% confidence intervals (CI).

RESULTS: Of 374 eligible patients, 81 (22%) were treated with adjuvant HAIP chemotherapy. The median follow-up for survivors was 65 months (IQR 32-118 months). Patients receiving adjuvant HAIP were more likely to have multifocal disease and receive perioperative systemic chemotherapy at time of resection for recurrence. A median hDFS of 46 months (95% CI 29-81 months) was found in patients treated with adjuvant HAIP compared with 18 months (95% CI 15-26 months) in patients treated with resection and/or ablation alone (p = 0.001). The median OS and 5-year OS were 89 months (95% CI 52-126 months) and 66%, respectively, in patients treated with adjuvant HAIP compared with 57 months (95% CI 47-67 months) and 47%, respectively, in patients treated with resection and/or ablation only (p = 0.002). Adjuvant HAIP was associated with superior hDFS (adjusted HR 0.599, 95% CI 0.38-0.93, p = 0.02) and OS (adjusted HR 0.59, 95% CI 0.38-0.92, p = 0.02) in multivariable analysis.

CONCLUSION: Adjuvant HAIP chemotherapy after resection and/or ablation of recurrent CRLM is associated with superior hDFS and OS.

Original languageEnglish
Pages (from-to)808-816
Number of pages9
JournalAnnals of Surgical Oncology
Volume28
Issue number2
Early online dateJul 2020
DOIs
Publication statusPublished - Feb 2021

Bibliographical note

Publisher Copyright:
© 2020, The Author(s).

Research programs

  • EMC OR-01

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