title: Timing of two-stage liver resection during chemotherapy for otherwise unresectable colorectal metastases.
abstract: BACKGROUND
  Tumor downsizing by effective chemotherapy while increasing remnant liver volume by two-stage hepatectomy can expand eligibility for resection of otherwise unresectable liver metastases. However, optimal timing of two-stage hepatectomy with respect to chemotherapy is undetermined.
  
  
  METHODS
  We retrospectively analyzed the effect of timing of two-stage hepatectomy and chemotherapy using data from 95 patients whose colorectal liver metastases initially were considered unresectable.
  
  
  RESULTS
  In 21 of 22 (95 %) patients whose first liver resection preceded chemotherapy (Hx-CTx group) and in 39 of 73 (53 %) patients whose chemotherapy preceded surgery (CTx-Hx group), macroscopic complete resection ultimately was achieved (P < 0.01). Overall and disease-free survivals were comparable between groups. However, overall survival of patients not achieving complete resection in the CTx-Hx group was significantly poorer than that for patients achieving complete resection (P < 0.01). When the 21 patients with complete resection in the Hx-CTx group were compared to the 39 patients with complete resection in the CTx-Hx group, no difference in overall or disease-free survival was observed (P = 0.12 and P = 0.24, respectively), although poor response to chemotherapy was more frequent in the Hx-CTx group.
  
  
  CONCLUSIONS
  Optimal timing of hepatectomy and chemotherapy is difficult to specify, but performing the initial resection in a two-stage hepatectomy before chemotherapy may increase likelihood of macroscopic complete resection, even in patients with a poor response to chemotherapy or with limited courses of chemotherapy.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kumamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nojiri
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents