Abstract
Background We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). Study Design We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary endpoint was feasibility of TSH and analysis of factors associated with failure to complete the procedure. The secondary endpoint was the long-term survival analysis. Results Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3 CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to complete TSH was 21.5% and tumor progression was the most frequent reason for failure (18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM were not associated with significantly different risks of disease progression. Multivariable logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy was the only independent risk factor for failure to complete TSH. The 5- and 10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%, respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy ≤6 cycles was found to be the only independent predictor of overall and disease-free survival. Conclusions This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.
| Original language | English |
|---|---|
| Pages (from-to) | 285-294 |
| Number of pages | 10 |
| Journal | Journal of the American College of Surgeons |
| Volume | 219 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2014 |
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Keywords
- 2-stage hepatectomy
- Abbreviations and Acronyms
- colorectal liver metastases
- CRLM
- FRL
- future remnant liver
- portal vein embolization
- portal vein ligation
- PVE
- PVL
- TSH
ASJC Scopus subject areas
- Surgery
Cite this
Tumor progression during preoperative chemotherapy predicts failure to complete 2-stage hepatectomy for colorectal liver metastases : Results of an Italian multicenter analysis of 130 patients. / Giuliante, Felice; Ardito, Francesco; Ferrero, Alessandro; Aldrighetti, Luca; Ercolani, Giorgio; Grande, Gennaro; Ratti, Francesca; Giovannini, Ivo; Federico, Bruno; Pinna, Antonio D.; Capussotti, Lorenzo; Nuzzo, Gennaro.
In: Journal of the American College of Surgeons, Vol. 219, No. 2, 2014, p. 285-294.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Tumor progression during preoperative chemotherapy predicts failure to complete 2-stage hepatectomy for colorectal liver metastases
T2 - Results of an Italian multicenter analysis of 130 patients
AU - Giuliante, Felice
AU - Ardito, Francesco
AU - Ferrero, Alessandro
AU - Aldrighetti, Luca
AU - Ercolani, Giorgio
AU - Grande, Gennaro
AU - Ratti, Francesca
AU - Giovannini, Ivo
AU - Federico, Bruno
AU - Pinna, Antonio D.
AU - Capussotti, Lorenzo
AU - Nuzzo, Gennaro
PY - 2014
Y1 - 2014
N2 - Background We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). Study Design We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary endpoint was feasibility of TSH and analysis of factors associated with failure to complete the procedure. The secondary endpoint was the long-term survival analysis. Results Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3 CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to complete TSH was 21.5% and tumor progression was the most frequent reason for failure (18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM were not associated with significantly different risks of disease progression. Multivariable logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy was the only independent risk factor for failure to complete TSH. The 5- and 10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%, respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy ≤6 cycles was found to be the only independent predictor of overall and disease-free survival. Conclusions This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.
AB - Background We aimed to evaluate the feasibility and long-term results of 2-stage hepatectomy (TSH) in patients with bilobar colorectal liver metastases (CRLM). Study Design We performed a retrospective multicenter study including 4 Italian hepatobiliary surgery units. One hundred thirty patients were selected for TSH between 2002 and 2011. The primary endpoint was feasibility of TSH and analysis of factors associated with failure to complete the procedure. The secondary endpoint was the long-term survival analysis. Results Patients presented with synchronous CRLM in 80.8% of cases, with a mean number of 8.3 CRLM and with concomitant extrahepatic disease in 20.0% of cases. The rate of failure to complete TSH was 21.5% and tumor progression was the most frequent reason for failure (18.5% of cases). Primary tumor characteristics, type, number, and distribution of CRLM were not associated with significantly different risks of disease progression. Multivariable logistic regression analysis showed that tumor progression during prehepatectomy chemotherapy was the only independent risk factor for failure to complete TSH. The 5- and 10-year overall survival rates for patients who completed TSH were 32.1% and 24.1%, respectively, with a median survival of 43 months. Duration of prehepatectomy chemotherapy ≤6 cycles was found to be the only independent predictor of overall and disease-free survival. Conclusions This study showed that selection of patients by response to prehepatectomy chemotherapy may be extremely important before planning TSH because tumor progression while receiving prehepatectomy chemotherapy was associated with significantly higher risk of failure to complete the second stage. For patients who completed the TSH strategy, long-term outcomes can be achieved with results similar to those observed after single-stage hepatectomy.
KW - 2-stage hepatectomy
KW - Abbreviations and Acronyms
KW - colorectal liver metastases
KW - CRLM
KW - FRL
KW - future remnant liver
KW - portal vein embolization
KW - portal vein ligation
KW - PVE
KW - PVL
KW - TSH
UR - http://www.scopus.com/inward/record.url?scp=84904665805&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84904665805&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2014.01.063
DO - 10.1016/j.jamcollsurg.2014.01.063
M3 - Article
VL - 219
SP - 285
EP - 294
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 2
ER -