Is it safe and effective to perform repeated hepatectomies in a small-volume center ?

Background Repeated hepatectomies for colorectal liver metastases (CLM) are considered safe but are mostly carried out in highly specialized hepato-biliary units. Aim of this study was to review the outcomes of re-hepatectomies in the setting of a general surgery Division and to compare them with the data included in Livermetsurvey. Patients and Methods We made a retrospective analysis of all comers who underwent liver resection for CLM between January 2002 and December 2011 in our General Surgery Department. Postoperative outcome was analyzed and compared with a control group of single hepatectomies. Three-year survival rates were calculated by Kaplan-Mayer method. The differences in morbidity and mortality between the single-only and the repeated hepatectomies cohort were exhibited through the chi-square test. Our data were compared with the Livermetsurvey Registry. Results 74 patients underwent 101 hepatectomies for CLM. 20(27%) patients received 27 repeated hepatectomies for recurrent metastases, 17 had a second hepatectomy, 2 underwent a third hepatectomy and 1 had a fourth procedure. Postoperative mortality was 1,3% after first hepatectomies and nihil after repeated resections. No difference in terms of mortality was observed between first and second hepatectomies (p=0.79). Postoperative morbidity after the first hepatectomy was 16%, while with repeated resections reached 30%.(p=0.3) The three-year overall survivals after the first and the repeated hepatectomies were respectively 61% and 39%, similar to the data reported by the Livermetsurvey Registry (61% and 58%). Conclusion Repeated hepatectomies for colorectal liver metastases may be performed safely in a relatively low-volume center with good outcomes. The survival rates are equivalent to those reported by Livermetsurvey.