title: Feasibility and survival of 2-stage hepatectomy for colorectal metastases: definition of a simple and early clinicopathologic predicting score.
abstract: BACKGROUND
  Bilobar colorectal metastases may be treated by a 2-stage surgical strategy. The risk of drop out after the first stage hepatectomy remains high and is associated with a nearly zero survival rate at 3 years. Our goal was to evaluate the factors predictive of the feasibility of the strategy and long-term survival, based on simple clinical and histologic features obtained from the first stage specimen.
  
  
  METHODS
  Patients who underwent a first stage hepatectomy with curative intent were included. Preoperative clinical parameters and histologic features of the primary neoplasm and metastases obtained at the first stage hepatectomy were analyzed and compared between patients who did or did not undergo the second stage operation. A group of comparable patients treated only by chemotherapy was used as a control group.
  
  
  RESULTS
  The feasibility rate of this 2-stage resection was 76% (38/50 patients). Median survival was greater in patients treated with chemotherapy alone than for those who failed the second stage. A clinicopathologic score including male sex, segment 1 metastasis, need for >3 resection(s)/radiofrequency ablation(s), vascular invasion in the primary, need for change in type of chemotherapy, and microscopic biliary invasion by the metastasis was predictive of feasibility of the second stage and disease-free survival in patients achieving the second stage.
  
  
  CONCLUSIONS
  Combining preoperative clinical parameters with pathologic features of the primary and the metastatic lesions obtained during first stage hepatectomy predicted accurately patients who failed the second stage, and the long-term outcomes. Considering both clinical and pathologic parameters may help to define the best oncologic strategy by choosing between an exclusive chemotherapeutic or a surgical strategy.
authors: Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France.
authors: Francois
authors: F
authors: Faitot
authors: Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France.
authors: Olivier
authors: O
authors: Soubrane
authors: Pathology, Hôpital Saint Antoine, Paris, France.
authors: Dominique
authors: D
authors: Wendum
authors: Pathology, Hôpital Saint Antoine, Paris, France.
authors: Jeremy
authors: J
authors: Sandrini
authors: Oncology, Hôpital Saint Antoine, Paris, France.
authors: Pauline
authors: P
authors: Afchain
authors: General Surgery, Hôpital Saint Antoine, Paris, France.
authors: Pierre
authors: P
authors: Balladur
authors: Oncology, Hôpital Saint Antoine, Paris, France.
authors: Aimery
authors: A
authors: de Gramont
authors: Departments of Hepatobiliary Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France. Electronic address: olivier.scatton@sat.aphp.fr.
authors: Olivier
authors: O
authors: Scatton
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging