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

Felice Giuliante, Francesco Ardito, Alessandro Ferrero, Luca Aldrighetti, Giorgio Ercolani, Gennaro Grande, Francesca Ratti, Ivo Giovannini, Bruno Federico, Antonio D. Pinna, Lorenzo Capussotti, Gennaro Nuzzo

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)285-294
Number of pages10
JournalJournal of the American College of Surgeons
Volume219
Issue number2
DOIs
Publication statusPublished - 2014

Fingerprint

Hepatectomy
Neoplasm Metastasis
Drug Therapy
Liver
Neoplasms
Survival Analysis
Patient Selection
Statistical Factor Analysis
Multicenter Studies
Disease-Free Survival
Disease Progression
Survival Rate
Retrospective Studies
Logistic Models
Regression Analysis
Survival

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 journalArticle

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. / 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. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 2. pp. 285-294.
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title = "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",
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.",
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author = "Felice Giuliante and Francesco Ardito and Alessandro Ferrero and Luca Aldrighetti and Giorgio Ercolani and Gennaro Grande and Francesca Ratti and Ivo Giovannini and Bruno Federico and Pinna, {Antonio D.} and Lorenzo Capussotti and Gennaro Nuzzo",
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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.

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KW - Abbreviations and Acronyms

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KW - FRL

KW - future remnant liver

KW - portal vein embolization

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KW - PVE

KW - PVL

KW - TSH

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