title: Short Chemotherapy-Free Interval Improves Oncological Outcome in Patients Undergoing Two-Stage Hepatectomy for Colorectal Liver Metastases.
abstract: In patients undergoing two-stage hepatectomy (TSH) for colorectal liver metastases (CRLM), chemotherapy is discontinued before portal vein occlusion and restarted after curative resection. Long chemotherapy-free intervals (CFI) may lead to tumor progression and poor oncological outcomes.
  
  
  
  The aim of this study was to investigate the impact of the length of CFI on oncological outcome in patients undergoing TSH for CRLM.
  
  
  
  Overall, 74 patients suffering from bilobar CRLM who underwent ALPPS (associating liver partition with portal vein ligation for staged hepatectomy; n = 43) or conventional TSH (n = 31) at two tertiary centers were investigated. The impact of CFI on long-term outcomes was analyzed by univariable and multivariable analysis.
  
  
  
  Preoperative chemotherapy was administered in 91 % (67/74) of patients, and chemotherapy was resumed postoperatively in 69 % (44/64) of patients who completed TSH. The use of postoperative chemotherapy was significantly associated with improved mean overall survival (36 ± 3 vs. 13 ± 3 months; p < 0.001). Overall, the median CFI from surgery to postoperative chemotherapy was 16 weeks (interquartile range 11-31) and was significantly shorter in the ALPPS group when compared with the conventional TSH group (10 vs. 21 weeks; p < 0.001). Multivariable analysis revealed a CFI ≤ 10 weeks as an independent factor associated with improved overall survival (p = 0.006) and disease-free survival (p = 0.010).
  
  
  
  A short CFI is associated with improved oncological outcome in patients undergoing TSH for CRLM. Decreased interstage intervals after ALPPS may facilitate the timely resumption of chemotherapy.
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Kambakamba
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Linecker
authors.affiliation: Department of General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: F A
authors.initials: FA
authors.lastname: Alvarez
authors.affiliation: Department of Oncology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Samaras
authors.affiliation: Department of Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: C S
authors.initials: CS
authors.lastname: Reiner
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: D A
authors.initials: DA
authors.lastname: Raptis
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Kron
authors.affiliation: Department of General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: E
authors.initials: E
authors.lastname: de Santibanes
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Petrowsky
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss HPB Center, University Hospital Zurich, Zurich, Switzerland. mickael.lesurtel@usz.ch.|Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon, Lyon, France. mickael.lesurtel@usz.ch.
authors.forename: M
authors.initials: M
authors.lastname: Lesurtel
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D066066:Response Evaluation Criteria in Solid Tumors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000970:Antineoplastic Agents