A comparative study of patients with and without associated digestive surgery in a two-stage hepatectomy setting.
OBJECTIVE
The purpose of this study was to compare the feasibility and outcomes of two-stage hepatectomy in patients with or without accompanying digestive surgery.


METHODS
We analyzed prospectively data from 56 patients with colorectal liver metastases undergoing two-stage hepatectomy between 1995 and 2009. Patients undergoing associated digestive resection (group I, n = 32) were compared with patients without associated digestive surgery (group II, n = 17).


RESULTS
The feasibility rate was 87.5% (49 patients). Neither the type and extent of hepatectomy nor the type of chemotherapy administered differed between the two groups. The median interval between hepatectomies was 1.79 and 2.07 months for groups I and II, respectively (not significant). One patient (group I) died of liver failure after the second hepatectomy. Postoperative morbidity rates were comparable: 37.5% (group I) vs. 35.5% (group II) after the first hepatectomy and 46.9% (group I) vs. 52.9% (group II) after the second hepatectomy. The median hospital stay after the first hepatectomy was longer in group I (13.5 days) than in group II (10 days) (P < 0.01). Median follow-up was 54 months. The median overall survival (OS) was 45.8 months, and 3- and 5-year OS were 58 and 31%, respectively. Median OS was longer for group II (58 months) than for group I (34 months) (P = 0.048).


CONCLUSIONS
Digestive tract resection associated with two-stage hepatectomy does not increase postoperative mortality or morbidity nor does it lead to delay in chemotherapy or a reduction in cycles administered. The need for digestive tract surgery should not affect the surgical management of two-stage hepatectomy patients.
Department of Surgery, Centre Léon Bérard, 69008, Lyon, France.
Mattia
M
Stella
Aurélien
A
Dupre
Sylvie
S
Chabaud
Alessandro
A
Gandini
Pierre
P
Meeus
Patrice
P
Peyrat
Michel
M
Rivoire
D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged