Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival
| Autor: | Riccardo Pellicci, A. Percivale, Guido Griseri, Michela Ceriotti, Marco Benasso, Gregorio Santori, Angelo Franceschi |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty medicine.medical_treatment perioperative safety Hospitals Community 030230 surgery 03 medical and health sciences 0302 clinical medicine Long term survival medicine Two-stage hepatectomy colorectal liver metastases perioperative safety long-term survival Hepatectomy Humans Stage (cooking) Aged Aged 80 and over Chemotherapy Two-stage hepatectomy business.industry General surgery Disease progression Liver Neoplasms General Medicine Perioperative Middle Aged Community hospital Neoadjuvant Therapy Surgery colorectal liver metastases Oncology Liver Two stage hepatectomy Chemotherapy Adjuvant 030220 oncology & carcinogenesis Disease Progression Female business Colorectal Neoplasms long-term survival |
| Zdroj: | Tumori. 103(2) |
| ISSN: | 2038-2529 |
| Popis: | IntroductionSurgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals.MethodsOf 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14.6%) were scheduled for TSH. Thirty-eight/43 received neoadjuvant and/or bridge chemotherapy (2 neoadjuvant only, 4 neoadjuvant and bridge, 32 bridge only).ResultsThe mean follow-up was 35.74 ± 29.53 months. Five-year overall survival (OS) was 31.4%, with a median survival time of 31 months. Twenty-nine patients completed the planned procedure (OS: 42.9%; median 47 months), while 14 did not because of disease progression (OS: 0%; median 13 months). No operative mortality occurred within the first 90 days either after the first or second stage.ConclusionsOur results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome. |
| Databáze: | OpenAIRE |
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