HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Not all early recurrences define futility: relapse patterns shape outcomes after colorectal liver metastases resection.
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Marino Rebecca, Silvia Buonanno, Marco Catena, Alessandris Remo, Mini Emanuele, Cipriani Federica, Ruotolo Luca, Bonini Chiara, Ratti Francesca
Аннотация
BACKGROUND: Recurrence after curative resection of colorectal liver metastases (CRLM) is heterogeneous. Early recurrence not always implies futile surgery. This study distinguishes predictors of early recurrence versus futile surgery and examines recurrence patterns.
METHODS: This study analyzed the prospective LiMeT cohort of patients undergoing curative-intent resection for CRLM at IRCCS San Raffaele. Early recurrence was defined as <12 months and futile surgery as Time-to-Surgical-Failure (TSF) < 12 months (unresectable recurrence, progression, or death). Logistic regression identified predictors, and Sankey analysis mapped recurrence characteristics.
RESULTS: Two hundred twenty-eight patients were included: 74 without recurrence, 115 early recurrences, and 39 late recurrences. Early recurrence was independently associated with synchronous CRLM (OR1.56, p = 0.02), primary tumor N1-N2 stage (OR2.23, p < 0.01), KRAS mutation (OR2.40, p = 0.024), ≥5 CRLM (OR2.15, p < 0.01), and metastatic diameter ≥3 cm (OR2.19, p < 0.01). Futility was associated with age>65, T4 stage, KRAS mutation, and no adjuvant chemotherapy. Sankey analysis showed that early recurrence not always leads to futility, often remaining liver-limited or oligometastatic.
CONCLUSION: Early recurrence and futile surgery represent distinct forms of postoperative failure. Early recurrence reflects tumor burden and biology, whereas futility identifies relapse that becomes unresectable or fatal, negating benefit. TSF provides complementary information on the durability of surgical benefit.
METHODS: This study analyzed the prospective LiMeT cohort of patients undergoing curative-intent resection for CRLM at IRCCS San Raffaele. Early recurrence was defined as <12 months and futile surgery as Time-to-Surgical-Failure (TSF) < 12 months (unresectable recurrence, progression, or death). Logistic regression identified predictors, and Sankey analysis mapped recurrence characteristics.
RESULTS: Two hundred twenty-eight patients were included: 74 without recurrence, 115 early recurrences, and 39 late recurrences. Early recurrence was independently associated with synchronous CRLM (OR1.56, p = 0.02), primary tumor N1-N2 stage (OR2.23, p < 0.01), KRAS mutation (OR2.40, p = 0.024), ≥5 CRLM (OR2.15, p < 0.01), and metastatic diameter ≥3 cm (OR2.19, p < 0.01). Futility was associated with age>65, T4 stage, KRAS mutation, and no adjuvant chemotherapy. Sankey analysis showed that early recurrence not always leads to futility, often remaining liver-limited or oligometastatic.
CONCLUSION: Early recurrence and futile surgery represent distinct forms of postoperative failure. Early recurrence reflects tumor burden and biology, whereas futility identifies relapse that becomes unresectable or fatal, negating benefit. TSF provides complementary information on the durability of surgical benefit.