Predictors of early disease recurrence following hepatic resection for colorectal cancer metastasis H.Z. Malik, D. Gomez, V. Wong, A. Al-Mukthar, G.J. Toogood, J.P.A. Lodge, K.R. Prasad * Hepatobiliary and Transplantation Unit, The Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK Accepted 5 January 2007 Available online 9 March 2007 Abstract Background: With the broadening indications of hepatic resection for colorectal liver metastases (CRLM), the exact group of patients who would benefit from surgery is still debatable. The aim of this study was to identify predictors for early recurrence, defined as recurrence within 6 months of CRLM resection, in order to identify those patients who may require further pre-operative radiological staging of the disease prior to surgery. Methods: Prospectively collected dataset of patients undergoing curative resection for CRLM during the 10-year period (January 1993eMay 2003) were analyzed. Patients who received neo-adjuvant chemotherapy and patients who underwent repeat hepatic resections whose primary resection was not performed during the study period were excluded. Results: Four hundred and thirty patients (89%) were included in the analysis. Eighty-six (20%) patients developed early recurrence. Early recurrence was associated with poorer outcome when compared to late recurrences ( p < 0.001). The predictor of early recurrence on mul- tivariable analysis was the presence of eight or more metastases ( p ¼ 0.036). Conclusion: We have identified a group of patients with multiple metastases who recur early following resection of CRLM. We suggest that these patients should be considered for additional pre-operative radiological workup in the form of PET scanning to identify those patients who would be deemed suitable for resection. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Colorectal liver metastases; Early recurrence; Multiple metastases Introduction Hepatic resection has become accepted as the optimal and potentially curative treatment for patients with colorec- tal liver metastases (CRLM). Results from various special- ized hepatobiliary centers have shown that surgical resection can potentially provide 5-year survival rates of 20e40%. 1e11 However, in selected groups of patients, a 58% 5-year survival rate has been reported. 10 Alterna- tively, untreated patients have a poor median survival of less than 12 months 12,13 and chemotherapy-only treatment is palliative but may prolong the survival of patients with unresectable disease. 14e16 A recent meta-analysis reported 10-year survival following resection of CRLM at 17e33%. 17 Nevertheless, up to 60% of patients undergoing hepatic resection for CRLM will develop recurrent disea- se. 18e21 This may represent technical failure, pre-operative under-staging of the disease or the biological aggressive- ness of the tumour. Traditionally hepatic resections for CRLM were only performed for solitary, uni-lobar disease using anatomical resection according to the segmental anatomy of the liver as described by Couinaud. 22 Fong et al. analyzed the pre- dictors of poorer long-term survival following resection for CRLM and identified five factors that correlated with poorer outcome. 23 In that series of 1001 patients, the actu- arial survival at 1 year was 89%. 23 However, the indications for hepatic resection have expanded during the last decade due to the improvement in anaesthetic techniques, better * Corresponding author. Tel.: þ44 113 2065921; fax: þ44 113 2448182. E-mail address: raj.prasad@leedsth.nhs.uk (K.R. Prasad). 0748-7983/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2007.01.005 EJSO 33 (2007) 1003e1009 www.ejso.com