title: Dangerous halo after neoadjuvant chemotherapy and two-step hepatectomy for colorectal liver metastases.
abstract: BACKGROUND
  Bilobar colorectal metastases are a therapeutic challenge and require a multidisciplinary approach. The aim of this study was to describe the clinical and histological outcomes of patients having neoadjuvant chemotherapy and two-step hepatectomy with right portal vein occlusion for advanced bilateral colorectal metastases.
  
  
  METHODS
  A series of 23 consecutive patients treated with curative intent according to a standardized multidisciplinary management protocol was reviewed.
  
  
  RESULTS
  Of 23 patients, 22 completed the programme. There was no mortality and no Clavien grade III morbidity. Median survival from the start of treatment was 45 months, and 1-, 3- and 5-year Kaplan-Meier estimates were 95, 73 and 27 per cent respectively. On histology at the first operation, ten patients had a dangerous halo of proliferating tumour cells infiltrating the surrounding liver parenchyma, of variable importance (six focal and four diffuse), regardless of the response to chemotherapy of the metastases. The dangerous halo increased in prevalence and importance (six focal and seven diffuse) between the first and second operation.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy followed by two-step hepatectomy with right portal vein occlusion is feasible, safe and may be advantageous to the patient. The appearance of a dangerous halo around the liver metastases may require adaptation of the surgical technique to decrease the risk of local recurrence.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 24 rue Micheli-du-Crest, Genève 14, Switzerland. gilles.mentha@hcuge.ch
authors.forename: G
authors.initials: G
authors.lastname: Mentha
authors.forename: S
authors.initials: S
authors.lastname: Terraz
authors.forename: P
authors.initials: P
authors.lastname: Morel
authors.forename: A
authors.initials: A
authors.lastname: Andres
authors.forename: E
authors.initials: E
authors.lastname: Giostra
authors.forename: A
authors.initials: A
authors.lastname: Roth
authors.forename: L
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: P
authors.initials: P
authors.lastname: Majno
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms; D004621:Embolization, Therapeutic / Q000379:methods / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D011169:Portal Vein; D011182:Postoperative Care / Q000401:mortality; D012086:Reoperation / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome