title: Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival.
abstract: BACKGROUND
  Surgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals.
  
  
  METHODS
  Of 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14.6%) were scheduled for TSH. Thirty-eight/43 received neoadjuvant and/or bridge chemotherapy (2 neoadjuvant only, 4 neoadjuvant and bridge, 32 bridge only).
  
  
  RESULTS
  The mean follow-up was 35.74 ± 29.53 months. Five-year overall survival (OS) was 31.4%, with a median survival time of 31 months. Twenty-nine patients completed the planned procedure (OS: 42.9%; median 47 months), while 14 did not because of disease progression (OS: 0%; median 13 months). No operative mortality occurred within the first 90 days either after the first or second stage.
  
  
  CONCLUSIONS
  Our results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome.
authors.affiliation: General Surgery Unit, San Paolo Hospital, Savona - Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Griseri
authors.affiliation: Postgraduate School of General Surgery, University of Genoa, Genoa - Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Ceriotti
authors.affiliation: General Surgery Unit, Santa Corona Hospital, Pietra Ligure (Savona)- Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Percivale
authors.affiliation: General Surgery Unit, San Paolo Hospital, Savona - Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Franceschi
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa - Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santori
authors.affiliation: Medical Oncology Division, San Paolo Hospital, Savona - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benasso
authors.affiliation: General Surgery Unit, Santa Corona Hospital, Pietra Ligure (Savona)- Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pellicci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006764:Hospitals, Community; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods