title: Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival.
abstract: BACKGROUND
  Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
  
  
  METHODS
  From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998-2006). In patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed if indicated.
  
  
  RESULTS
  One- (group I) and two-stage (group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of metastases in groups I and II were two (range 1-20) and seven (range 2-20). All patients in group II had bilateral disease vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18 group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage, respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality (2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%, respectively in group II (P = NS).
  
  
  CONCLUSIONS
  Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy. This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery with good outcomes.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA.
authors.forename: Yun Shin
authors.initials: YS
authors.lastname: Chun
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: David Z
authors.initials: DZ
authors.lastname: Chang
authors.forename: Linus
authors.initials: L
authors.lastname: Ho
authors.forename: Scott
authors.initials: S
authors.lastname: Kopetz
authors.forename: Steven H
authors.initials: SH
authors.lastname: Wei
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D018570:Risk Assessment