Early unresectable relapse after hepatic resection for colorectal liver metastases: a focus on time to surgical failure

Hepatic resection is the only potential cure for colorectal liver metastases (CRLMs), but early recurrence is common. Re-resections provide long-term survival benefits. Time to Surgical Failure (TSF), defined as the time from liver resection to unresectable recurrence, may be a more reliable surrogate for overall survival (OS) than disease-free survival (DFS). Despite curative surgeries, unresectable hepatic relapse within 12 months is frequent, raising concerns about the surgical benefits. Study aims were to evaluate the association between TSF and OS in patients with CRLMs undergoing curative resections, and to identify factors associated with futile surgery (unresectable recurrence or death within 12 months). A monocentric, retrospective study was conducted using data from 183 patients who underwent curative hepatic resection for CRLMs at San Raffaele Hospital, between 2019 and 2024. TSF, DFS, and OS were evaluated using Kaplan–Meier curves and correlation analyses. Univariable and multivariable logistic regression analyses were used to assess factors associated with futile surgery. After a median follow-up of 18 months, 30% patients died, 51% relapsed, and 41% developed unresectable hepatic recurrences. TSF better correlated with OS than DFS in both alive (rs = 0.61, p < 0.0001; rs = 0.37, p = 0.003) and dead (rs = 0.45, p = 0.008; rs = 0.29, p = 0.12) patients. Age > 65 years, KRAS mutation, T4 primary tumor stage, and absence of adjuvant chemotherapy associated with higher rates of futile surgery, though none were independent predictors. TSF appears to be a more reliable surrogate for OS than DFS in patients with resected CRLMs. Larger studies are needed to validate our findings.