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Multicenter Study
. 2010 May;12(4):262-9.
doi: 10.1111/j.1477-2574.2010.00161.x.

Two-stage strategy for patients with extensive bilateral colorectal liver metastases

Susan Tsai  1 , Hugo P Marques, Mechteld C de Jong, Paulo Mira, Vasco Ribeiro, Michael A Choti, Richard D Schulick, Eduardo Barroso, Timothy M Pawlik
Affiliations
Multicenter Study

Two-stage strategy for patients with extensive bilateral colorectal liver metastases

Susan Tsai et al. HPB (Oxford). 2010 May.

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.

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Figures

Figure 3
Figure 3
Patients who completed the two-stage approach had a similar overall survival as patients who were able to be treated with a planned single-stage hepatectomy
Figure 2
Figure 2
Three-year survival for patients completing a two-stage hepatectomy was 58% compared with only 18% for patients who failed to complete both stages
Figure 1
Figure 1
Overall disease-free survival was comparable between patients who completed the two-stage approach and those who underwent a planned single-stage hepatectomy
See this image and copyright information in PMC

References

    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, 2009. CA Cancer J Clin. 2009;59:225–249. - PubMed
    1. Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984;119:647–651. - PubMed
    1. Berney T, Mentha G, Roth AD, Morel P. Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg. 1998;85:1423–1427. - PubMed
    1. Bismuth H, Adam R, Levi F, Farabos C, Waechter F, Castaing D, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224:509–520. discussion 20–2. - PMC - PubMed
    1. Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET) Ann Surg. 2004;240:438–447. discussion 47–50. - PMC - PubMed

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