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Few cases of repeated hepatic resection for recurrent metastasis have been in literature. This paper focuses on metastatic recurrences and their surgical treatment, comparing the outcome of resective therapy with the natural history of metastases. Results of alternative methods (alcoholization and trans-arterial chemo-embolization), are evaluated through the analysis of indications, complications and real benefit.Between January 1980 and Jan 1995, 163 patients with hepatic metastases were operated on in our Department. In 132 cases, metastases originated from colorectal cancer: 105 were submitted to hepatic resection, 3 were treated by selective ischemia, 5 by chemotherapy through an infusaid catheter, 5 by alcoholization under ultrasonographic control, 14 by a new phase II trial of schedule oriented biochemical modulation of FUra bolus by MTX and B interferon and FUra continuous infusion by leucovorin.Out of 76 metachronous metastases operated on, 10 were metastatic hepatic recurrences surgically treated by second resection. The average time-interval intercurring between the two hepatic resections was 15 months. The average follow-up and survival period after repeated resection was 27 months (range 2-129).Through the analysis of these ten cases, we sorted out the segmentary localization of hepatic metastases, the type of operation performed, the disease free interval, serum CEA patterns, morbidity and survival. |
