Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: A Multi-institutional Analysis

Autor: Georgios A. Margonis, Thomas A. Aloia, Callisia N. Clarke, Susan Tsai, Timothy M. Pawlik, Harveshp Mogal, Michael I. D’Angelica, T. Clark Gamblin, Mariana I. Chavez, Daniel Eastwood, Cecilia G. Ethun, Shishir K. Maithel, Sepideh Gholami, Bradford J. Kim, Kathleen K. Christians
Rok vydání: 2021
Předmět:
Zdroj: Ann Surg Oncol
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-020-09459-6
Popis: BACKGROUND: Two-stage hepatectomy (TSH) is an important tool in the management of bilateral colorectal liver metastases (CRLM). This study sought to examine the presentation, management and outcomes of patients completing TSH in major hepato-biliary centers in the United States. METHODS: A retrospective review from 5 liver centers in the United States identified patients who completed a TSH procedure for bilateral CRLM. RESULTS: From December 2000 to March 2016, a total of 196 patients were identified. The majority of procedures were performed with an open technique (n = 194, 99.5%). The median number of tumors was 7 (range, 2–33). One-hundred twenty-eight (65.3%) patients underwent portal vein embolization. More patients received chemotherapy prior to the first stage than chemotherapy administration preceding the second stage (92% vs. 60%, p = 0.308). Median overall survival was 50 months with a median follow-up of 28 months (range, 2–143). Hepatic artery infusion chemotherapy was administered to 64 (32.7%) patients with similar overall survival (OS) to those managed without an infusion pump (p = 0.848). Postoperative morbidity following the second stage resection was 47.4%. Chemotherapy prior to the second stage did not demonstrate an increased complications rate (p = 0.202). Readmission following the second stage was 10.3% and was associated with a decrease in disease-free survival (p = 0.003). Overall survival was significantly decreased by positive resection margins and increased estimated blood loss (EBL) (p = 0.036 and p = 0.05, respectively). CONCLUSION: This is the largest TSH series in the U.S. and demonstrates evidence of safety and feasibility in the management of bilateral CRLM. Outcomes are influenced by margin status and operative EBL.
Databáze: OpenAIRE
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