TY - JOUR
T1 - 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
AU - Giuliante, Felice
AU - Ardito, Francesco
AU - Ferrero, Alessandro
AU - Aldrighetti, Luca
AU - Ercolani, Giorgio
AU - Grande, Gennaro
AU - Ratti, Francesca
AU - Giovannini, Ivo
AU - Federico, Bruno
AU - Pinna, Antonio D.
AU - Capussotti, Lorenzo
AU - Nuzzo, Gennaro
PY - 2014
Y1 - 2014
N2 - BACKGROUND: We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in
patients with bilobar colorectal liver metastases (CRLM).
STUDY DESIGN: We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery
units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary
endpoint was feasibility of TSH and analysis of factors associated with failure to complete
the procedure. The secondary endpoint was the long-term survival analysis.
RESULTS: Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3
CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to
complete TSH was 21.5% and tumor progression was the most frequent reason for failure
(18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM
were not associated with significantly different risks of disease progression. Multivariable
logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy
was the only independent risk factor for failure to complete TSH. The 5- and
10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%,
respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy
6 cycles was found to be the only independent predictor of overall and disease-free
survival.
CONCLUSIONS: This study showed that selection of patients by response to prehepatectomy chemotherapy
may be extremely important before planning TSH because tumor progression while receiving
prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete
the second stage. For patients who completed the TSH strategy, long-term outcomes
can be achieved with results similar to those observed after single-stage hepatectomy
AB - BACKGROUND: We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in
patients with bilobar colorectal liver metastases (CRLM).
STUDY DESIGN: We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery
units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary
endpoint was feasibility of TSH and analysis of factors associated with failure to complete
the procedure. The secondary endpoint was the long-term survival analysis.
RESULTS: Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3
CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to
complete TSH was 21.5% and tumor progression was the most frequent reason for failure
(18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM
were not associated with significantly different risks of disease progression. Multivariable
logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy
was the only independent risk factor for failure to complete TSH. The 5- and
10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%,
respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy
6 cycles was found to be the only independent predictor of overall and disease-free
survival.
CONCLUSIONS: This study showed that selection of patients by response to prehepatectomy chemotherapy
may be extremely important before planning TSH because tumor progression while receiving
prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete
the second stage. For patients who completed the TSH strategy, long-term outcomes
can be achieved with results similar to those observed after single-stage hepatectomy
KW - Colorectal liver metastases
KW - Liver resection
KW - Long term survival
KW - Preoperative chemotherapy
KW - Prognosis prediction
KW - Recurrence
KW - Response to chemotherapy
KW - Colorectal liver metastases
KW - Liver resection
KW - Long term survival
KW - Preoperative chemotherapy
KW - Prognosis prediction
KW - Recurrence
KW - Response to chemotherapy
UR - http://hdl.handle.net/10807/63606
U2 - 10.1016/j.jamcollsurg.2014.01.063
DO - 10.1016/j.jamcollsurg.2014.01.063
M3 - Article
SN - 1072-7515
VL - 219
SP - 285
EP - 294
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
ER -