title: Multimodal treatment options for bilobar colorectal liver metastases.
abstract: OBJECTIVE
  We evaluated individualized multimodal oncological strategies in patients with bilobular colorectal liver metastases (biCRC-LM) as well as their effect on R0 resection rates, disease-free survival (DFS), and overall survival (OS).
  
  
  METHODS
  Between January 2001 and December 2008, 64 patients were assigned to straightforward or two-stage liver resection +/- preoperative 5-fluorouracil (5FU)-based chemotherapy (CTx). Postoperative strategy after R0-resection was either "wait and see" or "adjuvant" therapy (3 cycles of CTx or anti-carcinoembryonic antigen (CEA)-radioimmunotherapy with (131)I-labetuzumab in a dose of 40-50 mCi/m(2)).
  
  
  RESULTS
  Forty-three initially unresectable patients received preoperative CTx for downsizing of their biCRC-LM. Straightforward or two-stage liver resection was intended in 40 and 24 patients, respectively. Histopathologically confirmed R0-liver resection could be achieved in 47 patients. Surgical morbidity and mortality rates were 33% and 1.5%, respectively. Postoperatively, 26 patients received anti-cancer therapy (5 x CTx, 21 x anti-CEA-radioimmunotherapy). After R0-liver resection, median OS was significantly better compared to R1/R2 resections followed by palliative 5FU-CTx (38 versus 19 months, p = 0.035). There was no significant difference in DFS (p = 0.650) and OS (p = 0.435) between straightforward and two-stage liver resection. Compared to "wait and see" strategy, the application of postoperative therapy in adjuvant intent was associated with a better OS (p = 0.048).
  
  
  CONCLUSIONS
  Extensive liver resection within multimodal treatment concepts is justified in patients with biCRC-LM when complete resection of all metastases seems to be achievable.
authors.affiliation: Department of General and Visceral Surgery, University Medical Centre, Georg-August University Goettingen, Robert-Koch-Strasse 40, 37073, Goettingen, Germany. khomayounfar@chirurgie-goettingen.de
authors.forename: Kia
authors.initials: K
authors.lastname: Homayounfar
authors.forename: Torsten
authors.initials: T
authors.lastname: Liersch
authors.forename: Martin
authors.initials: M
authors.lastname: Niessner
authors.forename: Johannes
authors.initials: J
authors.lastname: Meller
authors.forename: Thomas
authors.initials: T
authors.lastname: Lorf
authors.forename: Heinz
authors.initials: H
authors.lastname: Becker
authors.forename: B Michael
authors.initials: BM
authors.lastname: Ghadimi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002272:Carcinoembryonic Antigen / Q000276:immunology; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016499:Radioimmunotherapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002272:Carcinoembryonic Antigen