Feasibility, safety and efficacy of two-stage hepatectomy for bilobar liver metastases of colorectal cancer: a LiverMetSurvey analysis.
The combination of liver resection and chemotherapy has become the standard of care for colorectal liver metastases (LM). The objective of the present study was to evaluate the impact of two-stage hepatectomy (TSH) on the long-term survival of patients with bilobar LM.



We included adult (over-18) patients from the LiverMetSurvey registry with confirmed multiple colorectal LM and having undergone either one-stage hepatectomy or TSH with curative intent. The "TSH (2/2)" group (n = 625) comprised patients having completed both stages of TSH; the "TSH (1/2)" group (n = 244) comprised patients having undergone only the first stage of TSH; the "hepatectomy" group. The primary outcome criterion was the overall survival (OS). The secondary outcomes were the morbidity and mortality rates.



The 30- and 90-day mortality rates were respectively 3.8% and 9.3% in the TSH (2/2) group, 9.4% and 16.4% in the TSH (1/2) group, and 5.4% and 9.1% in the "hepatectomy" group. The three-year OS rate was 45% in the TSH (2/2) group, 30% in the TSH (1/2) group and 50.7% in the hepatectomy group.



The LiverMetSurvey registry's data indicate that TSH is associated with rather good long-term survival and acceptable morbidity and mortality rates.
Digestive and Oncological Surgery Department, Amiens University Medical Center, Amiens, France; EA 4292, Jules Verne University of Picardy, Amiens, France; Clinical Research Center, Amiens University Medical Center, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
Jean Marc
JM
Regimbeau
Digestive and Oncological Surgery Department, Amiens University Medical Center, Amiens, France; Clinical Research Center, Amiens University Medical Center, Amiens, France.
Cyril
C
Cosse
Essen University Hospital, Essen, Germany.
Gernot
G
Kaiser
UCL Saint Luc, Brussels, Belgium.
Catherine
C
Hubert
Saint Andre Hospital, Bordeaux, France.
Christophe
C
Laurent
CHUM, Saint Luc Hospital, Montreal, Canada.
Real
R
Lapointe
Transplantation and Liver Surgery Helsinki University Hospital, Helsinki, Finland.
Helen
H
Isoniemi
Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Universitaire Paul Brousse, Villejuif, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.
Rene
R
Adam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D019538:Health Care Surveys; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult