Two-stage hepatectomy versus 1-stage resection combined with radiofrequency for bilobar colorectal metastases: a case-matched analysis of surgical and oncological outcomes.
OBJECTIVE
The aim of this study was to compare the long-term results of 2 surgical strategies for patients with bilobar colorectal liver metastases (bCRLM).


BACKGROUND
Two-stage hepatectomy is the surgical strategy mostly chosen for treating extensive BCLM with the pitfall of dropout after the first stage. One-stage strategy combining limited resections and radiofrequency ablation could be proposed as an option in this population.


METHODS
Between 2000 and 2010, 272 patients were consecutively operated in 2 expert centers practicing 1- or 2-stage hepatectomy for bCRLM. A case-match study (1:1) was conducted using number and size of nodules, synchronous presentation, primary node status, and extrahepatic disease as matching variables to compare overall survival (OS) and disease-free survival (DFS). The analysis was performed in intention to treat, including patients who did not undergo the second stage.


RESULTS
In the case-match analysis (156 matched patients), median OS and DFS did not differ significantly between patients in 1- and 2-stage hepatectomy, respectively: 37.2 and 34.5 months (P=0.6), 9.4 and 7.5 months (P=0.25). Multivariate analysis confirmed the absence of impact of strategy on OS and DFS. Primary advanced T stage and synchronous presentation were predictors of poor OS (HR=3.67 and 1.92); CEA more than 200 ng/mL, absence of postoperative chemotherapy, and extrahepatic disease were predictive of recurrence (HR=2.77, 1.85 and 1.69, respectively).


CONCLUSIONS
This first case-match study demonstrates that on an intention-to-treat analysis 1- and 2-stage hepatectomy in patients with bCRLM achieve comparable OS and DFS, despite the high dropout of the 2-stage strategy.
*Centre Hepato-biliaire, Hôpital Paul Brousse, APHP, Villejuif, France †Paris-Sud University, Kremlin-Bicêtre, France ‡General Surgical Oncology Department, Institut Gustave Roussy, Villejuif, France §Liver Surgery Unit, Department of General Surgery, University of Milan School of Medicine, Humanitas Cancer Center, Rozzano, Milan, Italy ¶UMRS776, Inserm, Villejuif, France.
François
F
Faitot
Mathieu
M
Faron
René
R
Adam
Dominique
D
Elias
Matteo
M
Cimino
Daniel
D
Cherqui
Eric
E
Vibert
Denis
D
Castaing
Antonio Sa
AS
Cunha
Diane
D
Goéré
D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D057194:Intention to Treat Analysis; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011846:Radio Waves; D015996:Survival Rate; D016896:Treatment Outcome