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Review
. 2023 Jun 21;57(2):270-278.
doi: 10.2478/raon-2023-0026. eCollection 2023 Jun 1.

Two-stage hepatectomy in resection of colorectal liver metastases - a single-institution experience with case-control matching and review of the literature

Spela Turk  1   2 , Irena Plahuta  1   2 , Tomislav Magdalenic  1 , Tajda Spanring  1   2 , Kevin Laufer  1   2 , Zan Mavc  1 , Stojan Potrc  1   2 , Arpad Ivanecz  1   2
Affiliations
Review

Two-stage hepatectomy in resection of colorectal liver metastases - a single-institution experience with case-control matching and review of the literature

Spela Turk et al. Radiol Oncol. .

Abstract

Background: Two-stage hepatectomy (TSH) has been proposed for patients with bilateral liver tumours who have a high risk of posthepatectomy liver failure after one-stage hepatectomy (OSH). This study aimed to determine the outcomes of TSH for extensive bilateral colorectal liver metastases.

Patients and methods: A retrospective review of a prospectively maintained database of liver resections for colorectal liver metastases was conducted. The TSH group was compared to the OSH group in terms of perioperative outcomes and survival. Case-control matching was performed.

Results: A total of 632 consecutive liver resections for colorectal liver metastases were performed between 2000 and 2020. The study group (TSH group) consisted of 15 patients who completed TSH. The control group included 151 patients who underwent OSH. The case-control matching-OSH group consisted of 14 patients. The major morbidity and 90-day mortality rates were 40% and 13.3% in the TSH group, 20.5% and 4.6% in the OSH group and 28.6% and 7.1% in the case-control matching-OSH group, respectively. The recurrence-free survival, median overall survival, and 3- and 5-year survival rates were 5 months, 21 months, 33% and 13% in the TSH group; 11 months, 35 months, 49% and 27% in the OSH group; and 8 months, 23 months, 36% and 21%, respectively, in the case-control matching-OSH group, respectively.

Conclusions: TSH used to be a favourable therapeutic choice in a select population of patients. Now, OSH should be preferred whenever feasible because it has lower morbidity and equivalent oncological outcomes to those of completed TSH.

Keywords: colorectal cancer; future liver remnant; hepatectomy; liver metastases; posthepatectomy liver failure; survival analysis.

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Figures

FIGURE 1.
FIGURE 1.
The study flowchart. The study period covers 1 January 2000 to 31 December 2020. ALPPS = associating liver partition and portal vein ligation for staged hepatectomy; CCM-OSH = case-control matching one-stage hepatectomy; CLMs = colorectal liver metastases; OSH = one-stage hepatectomy; PVE = portal vein embolization; PVL = portal vein ligation; RFA = radiofrequency ablation; TSH = two-stage hepatectomy
FIGURE 2.
FIGURE 2.
Overall survival after case-control matching (TSH vs. case-control matching-OSH groups), P = 0.575. CCM-OSH = case-control matching one-stage hepatectomy; TSH = two-stage hepatectomy
See this image and copyright information in PMC

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