Strategies to convert to resectability the initially unresectable colorectal liver metastases.
OBJECTIVE
Because only 25% of colorectal liver metastases (CRLM) are initially resectable, we used several therapeutic strategies to convert to resectability some of the initially unresectable CRLM. Our results are presented herein.


METHODS
The therapeutical strategies were: (A) Liver resection after portal vein ligation--10 patients; (B) Staged liver resection with portal vein ligation--3 patients; (C) Staged liver resection without portal vein ligation--3 patients; (D) Resection after "do wn-sizing" of CRLM by conversion chemotherapy--3 patients; (E) Resection associated with radiofrequency ablation--9 patients.


RESULTS
The resectability rate was 60% (6/10) in group A and 66% (2/3) in groups B and C. For the entire series, the morbidity and mortality rates were 50% (11/22 patients) and 4.5% (1/22 patients), respectively. The overall one-, two-, and three-year survival rates of the entire group of patients rendered to resectability were 80.1%, 44.8% and 35.9%, respectively.


CONCLUSIONS
In selected patients with initially unresectable CRLM, "two-stage" hepatectomies (with/without PVE/PVL) can be performed safely, achieving long-term survival. Liver resection may be achieved safely after conversion chemotherapy in some previously unresectable patients, with considerable survival benefit. RFA could be associated with liver resection to increase the number of patients eligible for complete removal and ablation of their CRLM.
Popescu
Irinel
I
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania. irinel.popescu@icfundeni.ro
Alexandrescu
Sorin
S
Croitoru
Adina
A
Boros
Mirela
M
D000970:Antineoplastic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D020360:Neoadjuvant Therapy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents