The impact of recurrence timing and tumor burden score on overall survival among patients undergoing repeat hepatectomy for colorectal liver metastases

Introduction: Approximately 15% of patients experience a resectable intrahepatic recurrence after an index curative-intent hepatectomy for colorectal liver metastases (CRLM). We sought to investigate the impact of recurrence timing and tumor burden score (TBS) at the time of recurrence on overall survival among patients undergoing repeat hepatectomy. Methods: Patients with CRLM who experienced recurrent intrahepatic disease after initial hepatectomy between 2000 and 2020 were identified from an international multi-institutional database. The impact of time–TBS, defined as TBS divided by the time interval of recurrence, was assessed relative to overall survival. Results: Among 220 patients, the median age was 60.9 years (interquartile range [IQR]: 53.0–69.0), and 144 (65.5%) patients were male. Most patients experienced multiple recurrences (n = 120, 54.5%) within 12 months after the initial hepatectomy (n = 139, 63.2%). The median tumor size of the recurrent CRLM was 2.2 cm (IQR: 1.5–3.0 cm) with a median TBS of 3.5 (2.3–4.9) at the time of recurrence. Overall, 121 (55.0%) patients underwent repeat hepatectomy, whereas 99 (45.0%) individuals were treated with systemic chemotherapy or other nonsurgical treatments; repeat hepatectomy was associated with better postrecurrence survival (PRS) (p < 0.001). Three-year PRS incrementally worsened (low time–TBS: 71.7%, 95% confidence interval [CI], 57.9-88.8 vs. medium: 63.6%, 95% CI, 47.7–84.8 vs. high: 49.2%, 95% CI, 31.1–77.7, p = 0.02) as time–TBS values increased. Each unit increase in time–TBS score was independently associated with a 41% higher possibility of death (hazard ratio: 1.41; 95% CI, 1.04–1.90, p = 0.03). Conclusions: Time–TBS was associated with long-term outcomes after repeat hepatectomy for recurrent CRLM. Time–TBS may be an easy tool to help select patients who may benefit the most from repeat hepatic resection of recurrent CRLM.