title: Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases.
abstract: OBJECTIVE
  To assess feasibility, risks, and long-term outcome of 2-stage hepatectomy as a means to improve resectability of colorectal liver metastases (CLM).
  
  
  BACKGROUND
  Two-stage hepatectomy uses compensatory liver regeneration after a first noncurative hepatectomy to enable a second curative resection.
  
  
  METHODS
  Between October 1992 and January 2007, among 262 patients with initially irresectable CLM, 59 patients (23%) were planned for 2-stage hepatectomy. Patients were eligible when single resection could not achieve complete treatment, even in combination with chemotherapy, portal embolization, or radiofrequency, but tumors could be totally removed by 2 sequential resections. Feasibility and outcomes were prospectively evaluated.
  
  
  RESULTS
  Two-stage hepatectomy was feasible in 41 of 59 patients (69%). Eighteen patients failed to complete the second hepatectomy because of disease progression (n = 17) or bad performance status (n = 1). The 41 successfully treated patients had a mean number of 9.1 metastases (mean diameter, 48.5 mm at diagnosis). Chemotherapy was delivered before (95%), in between (78%), and after (78%) the 2 hepatectomies. Mean delay between the 2 liver resections was 4.2 months. Postoperative mortality was 0% and 7% (3/41) after the first and second hepatectomy, respectively. Morbidity rates were also higher after the second procedure (59% vs. 20%) (P < 0.001). Five-year survival was 31% on an intention to treat basis, and all but 2 patients who did not complete the 2-stage strategy died within 19 months. After a median follow-up of 24.4 months (range, 3.7-130.3), overall 3- and 5-year survivals for patients that completed both hepatectomies were 60% and 42%, respectively, after the first hepatectomy (median survival, 42 months from first hepatectomy and 57 months from metastases diagnosis). Disease-free survivals were 26% and 13% at 3 and 5 years, respectively.
  
  
  CONCLUSIONS
  Two-stage hepatectomy provides a 5-year survival of 42% and a hope of long-term survival for selected patients with extensive bilobar CLM, irresectable by any other means.
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.forename: Rafael
authors.initials: R
authors.lastname: Miller
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Haas
authors.forename: Georgia
authors.initials: G
authors.lastname: Bitsakou
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Luc-Antoine
authors.initials: LA
authors.lastname: Veilhan
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D017679:Cryotherapy; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome