Long-term outcome and quality of life after initial and repeat resection of colorectal liver metastasis: A retrospective analysis.

BACKGROUND: Repeat hepatectomy is a widely accepted treatment for patients with recurrent colorectal liver metastasis (CRLM). The aim of this study was to compare initial and repeat hepatic resection concerning overall survival, prognostic factors and postoperative quality of life. METHODS: Data on patients who underwent initial or repeat hepatic resection for CRLM between 2010 and 2016 were prospectively collected and retrospectively evaluated. Follow-up data, EORTC QLQ-C30 and QLQ-LMC21 questionnaire results for quality of life (QoL) evaluation were analyzed. RESULTS: 160 patients at a median age of 62.8 ± 11.8 years were analyzed. 122 were initially resected and 38 underwent a repeat hepatic resection. Disease-free survival (DSF) was superior in the initial resection group (p < 0.001), while there was no difference in overall survival (OS) (p = 0.288). BMI >30 (p = 0.012), extrahepatic tumor manifestation (p = 0.037), >1 CRLM manifestation (p = 0.009), and perioperative chemotherapy (p = 0.006) in the initial resection group and primary left colon tumor (p = 0.001) in the repeat resection group were identified as prognostic factors in multivariate Cox regression analysis. EORTC QLQ-LMC-21 module symptom score displayed an increased occurrence of a dry mouth in the initial hepatectomy group (p = 0.003). EORTC QLQ-C30 general functioning and symptom scores showed no difference. CONCLUSION: Repeat hepatic resection for CRLM is as effective as primary surgical treatment in terms of OS and QoL. Patients should be selected carefully concerning prognostic factors as DFS is decreased after repeat hepatic resection.

Groundwater storage and water security: making better use of our largest reservoir.

Provision of sufficient storage capacity under growing water demands and increasing climate variability is one the main concerns for water managers in the coming decades. It is expected that 150-300 km3 of additional storage capacity will be needed by 2025 especially in semi-arid and arid regions where changes in climate variability will have most impact on rainfall and drought. Storage of substantial amounts of water can either be above ground, in reservoirs behind dams or underground in aquifers (sub-surface storage). Recharge enhancement through management of aquifer recharge (MAR) and sub-surface storage (SSS) is a known technology and already successfully applied in a number of countries for many years at different scales. MAR-SSS is a flexible and cost-effective means to increase storage capacity both at village level and in modern water management schemes. A dialogue and information exchange between climate experts and water managers can provide an effective contribution to the planning, design and operation of MAR-SSS schemes.