Tumor progression during preoperative chemotherapy predicts failure to complete 2-stage hepatectomy for colorectal liver metastases: results of an Italian multicenter analysis of 130 patients

BACKGROUND: We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in\r\npatients with bilobar colorectal liver metastases (CRLM).\r\nSTUDY DESIGN: We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery\r\nunits. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary\r\nendpoint was feasibility of TSH and analysis of factors associated with failure to complete\r\nthe procedure. The secondary endpoint was the long-term survival analysis.\r\nRESULTS: Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3\r\nCRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to\r\ncomplete TSH was 21.5% and tumor progression was the most frequent reason for failure\r\n(18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM\r\nwere not associated with significantly different risks of disease progression. Multivariable\r\nlogistic regression analysis showed that tumor progression during prehepatectomy chemotherapy\r\nwas the only independent risk factor for failure to complete TSH. The 5- and\r\n10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%,\r\nrespectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy\r\n 6 cycles was found to be the only independent predictor of overall and disease-free\r\nsurvival.\r\nCONCLUSIONS: This study showed that selection of patients by response to prehepatectomy chemotherapy\r\nmay be extremely important before planning TSH because tumor progression while receiving\r\nprehepatectomy chemotherapy was associated with significantly higher risk of failure to complete\r\nthe second stage. For patients who completed the TSH strategy, long-term outcomes\r\ncan be achieved with results similar to those observed after single-stage hepatectomy