Two-Stage hepatectomy versus 1-Stage Resection combined with radiofrequency for bilobar colorectal metastases a case-matched analysis of surgical and oncological outcomes

François Faitot, Mathieu Faron, René Adam, Dominique Elias, Matteo Cimino, Daniel Cherqui, Eric Vibert, Denis Castaing, Antonio Sa Cunha, Diane Goéré

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to compare the long-term results of 2 surgical strategies for patients with bilobar colorectal liver metastases (bCRLM). Background: Two-stage hepatectomy is the surgical strategy mostly chosen for treating extensive BCLM with the pitfall of dropout after the first stage. One-stage strategy combining limited resections and radiofrequency ablation could be proposed as an option in this population. Patients and Methods: Between 2000 and 2010, 272 patients were consecutively operated in 2 expert centers practicing 1- or 2-stage hepatectomy for bCRLM. A case-match study (1:1) was conducted using number and size of nodules, synchronous presentation, primary node status, and extrahepatic disease as matching variables to compare overall survival (OS) and disease-free survival (DFS). The analysis was performed in intention to treat, including patients who did not undergo the second stage. Results: In the case-match analysis (156 matched patients), median OS and DFSdid not differ significantly between patients in 1- And 2-stage hepatectomy, respectively: 37.2 and 34.5 months (P = 0.6), 9.4 and 7.5 months (P = 0.25). Multivariate analysis confirmed the absence of impact of strategy on OS and DFS. Primary advanced T stage and synchronous presentation were predictors of poor OS (HR = 3.67 and 1.92); CEA more than 200 ng/mL, absence of postoperative chemotherapy, and extrahepatic disease were predictive of recurrence (HR = 2.77, 1.85 and 1.69, respectively). Conclusions: This first case-match study demonstrates that on an intentionto- Treat analysis 1- And 2-stage hepatectomy in patients with bCRLM achieve comparable OS and DFS, despite the high dropout of the 2-stage strategy.

Original languageEnglish
Pages (from-to)822-828
Number of pages7
JournalAnnals of Surgery
Volume260
Issue number5
DOIs
Publication statusPublished - 2014

Keywords

  • 1-stage hepatectomy
  • 2-stage hepatectomy
  • Colorectal cancer
  • Liver metastases

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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