title: Tumor progression during preoperative chemotherapy predicts failure to complete 2-stage hepatectomy for colorectal liver metastases: results of an Italian multicenter analysis of 130 patients.
abstract: BACKGROUND
  We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM).
  
  
  METHODS
  We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary endpoint was feasibility of TSH and analysis of factors associated with failure to complete the procedure. The secondary endpoint was the long-term survival analysis.
  
  
  RESULTS
  Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3 CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to complete TSH was 21.5% and tumor progression was the most frequent reason for failure (18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM were not associated with significantly different risks of disease progression. Multivariable logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy was the only independent risk factor for failure to complete TSH. The 5- and 10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%, respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy ≥6 cycles was found to be the only independent predictor of overall and disease-free survival.
  
  
  CONCLUSIONS
  This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: francesco.ardito@rm.unicatt.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.affiliation: Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.affiliation: Liver Unit, San Raffaele Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Grande
authors.affiliation: Liver Unit, San Raffaele Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.affiliation: Faculty of Health and Sport Sciences, University of Cassino, Cassino, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.affiliation: Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.affiliation: Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents