Faculty Collaboration Database

Two-stage strategy for patients with extensive bilateral colorectal liver metastases. HPB (Oxford) 2010 May;12(4):262-9

Date

07/02/2010

Pubmed ID

20590896

Pubmed Central ID

PMC2873649

DOI

10.1111/j.1477-2574.2010.00161.x

Scopus ID

2-s2.0-77953555107 (requires institutional sign-in at Scopus site)   90 Citations

Abstract

BACKGROUND: Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases. The present study assesses the feasibility and outcome of two-stage hepatectomy for the treatment of colorectal liver metastases.

METHODS: From January 1994 to December 2008, 720 patients underwent liver resections at two institutions for colorectal liver metastases. The feasibility and outcomes of two-staged hepatectomies were evaluated.

RESULTS: Forty-five patients were eligible for the two-stage approach and both stages were completed in 35 patients (78%). Reasons for failure included disease progression (n= 7), poor performance status (n= 1) and death after the first stage (n= 2). Patients who completed both stages had significantly fewer lesions than patients who failed to complete the second stage (5 vs. 8; P= 0.02). No differences between the two groups were observed with regard to lesion size, receipt of radiofrequency ablation (RFA) or presence of extrahepatic disease. Post-operative morbidity (24% vs. 26%; P= 0.9) and mortality (4% vs. 5%; P= 0.8) was similar between the first and second stages. Median overall survival was 16 months. Three-year survival was significantly worse for patients failing to complete both stages (18%) compared with patients completing both stages (58%) (P < 0.001). Similar survival rates were observed between patients who completed two-stage vs. patients treated with a planned single-stage hepatectomy (58% vs. 53%; P= 0.34).

CONCLUSION: The two-stage strategy for colorectal liver metastases can be performed with acceptable morbidity and mortality. The second stage will not be feasible in 20-25% of patients. Patients who are able to complete the two-stage approach, however, may have long-term survival comparable to patients treated with a planned single-stage hepatectomy.

Author List

Tsai S, Marques HP, de Jong MC, Mira P, Ribeiro V, Choti MA, Schulick RD, Barroso E, Pawlik TM

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Baltimore
Chi-Square Distribution
Colorectal Neoplasms
Disease-Free Survival
Feasibility Studies
Female
Hepatectomy
Humans
Kaplan-Meier Estimate
Liver Neoplasms
Male
Middle Aged
Patient Selection
Portugal
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome