title: Failure to Achieve a 2-Stage Hepatectomy for Colorectal Liver Metastases: How to Prevent It?
abstract: OBJECTIVE
  The aim of the study was to identify predictive factors of failure of 2-stage hepatectomy (TSH) for the selection of patients with extensive bilobar colorectal liver metastases (CRLM), who are candidates for TSH.
  
  
  BACKGROUND
  The main weakness of TSH is the risk of failure to complete both the sequential procedures.
  
  
  METHODS
  Between 2000 and 2012, from a total cohort of 845 patients resected for CRLM, 125 patients (14.8%) with extensive CRLM were planned for TSH. All factors related to the failure of TSH were analyzed, and a predictive model was built utilizing the independent predictive factors of failure.
  
  
  RESULTS
  Forty-four patients (35.2%) could not proceed to the second stage, and their overall survival (OS) was significantly worse than that of those who completed the TSH (5-year OS: 0% vs 44.2%; P < 0.0001). Multivariate analysis revealed that carcinoembryonic antigen >30 ng/mL [relative risk (RR) 2.73, P = 0.03], tumor size >40 mm (RR 2.89, P = 0.04), chemotherapy cycles >12 (RR 3.46, P = 0.01), and tumor progression during first-line chemotherapy (RR 6.56, P = 0.01) were independent predictive factors of failure. For patients not presenting any factors, the probability of failure was 10.5%, with a 5-year OS rate of 41.9%. The addition of each subsequent factor increased the risk to 43.5%, 72.7%, 88.5%, and 95.5%, and decreased the 5-year OS to 38.8%, 29.2%, 0%, and 0%, respectively, for 1, 2, 3, and 4 factors.
  
  
  CONCLUSIONS
  TSH should not be recommended in patients with more than 2 risk factors. Avoidance of these factors significantly reduces the risk of failure and is crucial for long-term survival.
authors.affiliation: *Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France †Inserm, Unité 935, Villejuif, France ‡Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan §Université Paris-Sud, Villejuif, France ¶Inserm,Unité 785, Villejuif, France.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Imai
authors.forename: Carlos Castro
authors.initials: CC
authors.lastname: Benitez
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Allard
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure