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. 2024 Oct 1;110(10):6691-6701.
doi: 10.1097/JS9.0000000000001811.

Evaluation of two-stage hepatectomy using portal vein embolization for colorectal liver metastasis: a retrospective nationwide cohort survey in Japan

Takayuki Shimizu  1   2 , Taku Aoki  1   2 , Mitsuru Ishizuka  1   2 , Katsunori Sakamoto  1   3 , Toru Beppu  1   4 , Goro Honda  1   5 , Kenjiro Kotake  1   6 , Masakazu Yamamoto  1   7 , Keiichi Takahashi  1   8 , Itaru Endo  1   9 , Kiyoshi Hasegawa  1   10 , Michio Itabashi  1   5 , Yojiro Hashiguchi  1   11 , Yoshihito Kotera  1   5 , Shin Kobayashi  1   12 , Tatsuro Yamaguchi  1   13 , Soichiro Natsume  1   13 , Ken Tabuchi  1   14 , Hirotoshi Kobayashi  1   15 , Kensei Yamaguchi  1   16 , Kimitaka Tani  1   5 , Satoshi Morita  1   17 , Masaru Miyazaki  18 , Kenichi Sugihara  19 , Yoichi Ajioka  1   20
Affiliations

Evaluation of two-stage hepatectomy using portal vein embolization for colorectal liver metastasis: a retrospective nationwide cohort survey in Japan

Takayuki Shimizu et al. Int J Surg. .

Abstract

Introduction: Two-stage hepatectomy (TSH) enables patients to undergo surgery for colorectal liver metastasis (CRLM), which one-stage hepatectomy cannot remove. Although the outcome of TSH has been reported, there is no original report from Japan. The aim of this retrospective study was to evaluate the outcome of TSH in Japanese patients with CRLM.

Methods: The authors conducted a retrospective cohort study using the nationwide database that included clinical information of 12 519 patients treated with CRLM between 2005 and 2017 in Japan. The primary outcome measure was overall survival. The second outcome measure was progression-free survival. Fisher's exact test, χ 2 test and Mann-Whitney U test were conducted to examine an intergroup difference. Univariate and multivariate analyses were performed using Cox regression model. Survival analysis was performed by Kaplan-Meier method and log-rank test.

Results: Of the database, 53 patients undergoing TSH using portal vein embolization (PVE) were identified and analyzed. Their morbidity and in-hospital mortality rates at the second hepatectomy were 26.4% and 0.0%. The mean observation period was 21.8 months. The estimated 1-, 3- and 5-year overall survival rate were 92.5%, 70.8% and 34.7%. Multivariate analyses showed that more than 10 liver nodules significantly increased the mortality risk by 4.2-fold (95% CI 1.224-14.99, P = 0.023). Survival analysis revealed that repeat hepatectomy for disease progression after TSH was superior to chemotherapy in overall survival (mean: 49.6 vs. 18.7, months, P = 0.004).

Conclusion: In the Japanese cohort, TSH was confirmed to be a safety procedure with an acceptable survival outcome. More than 10 liver nodules may be a predictor for unfavorable outcomes of patients with CRLM undergoing TSH. Furthermore, repeat hepatectomy can be a salvage treatment for resectable intrahepatic recurrence after TSH.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Selection of the study population. CRLM, colorectal liver metastasis.
Figure 2
Figure 2
Overall and progression-free survival in patients undergoing two-stage hepatectomy for colorectal liver metastasis. (A) Overall survival, (B) progression-free survival.
Figure 3
Figure 3
Overall and progression-free survival in patients undergoing two-stage hepatectomy (TSH) for colorectal liver metastasis according to 10 liver nodules. (A) Overall survival, (B) progression-free survival. (C) Overall survival in patients with initially borderline resectable or unresectable liver disease who have more than 10 nodules according to one-stage hepatectomy (OSH) and two-stage hepatectomy (TSH). (D) Overall survival in patients undergoing TSH for colorectal liver metastasis according to number of treated nodules (TN) at the first hepatectomy (FH).
Figure 4
Figure 4
Overall survival in patients undergoing two-stage hepatectomy for colorectal liver metastasis according to (A) extrahepatic disease (EHD) and (B) the degree of residual tumor (R0, R1 and R2 resection).
See this image and copyright information in PMC

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