Chavez, Mariana I, Gholami, Sepideh, Kim, Bradford J, Margonis, Georgios A, Ethun, Cecilia G, Tsai, Susan, Christians, Kathleen K, Clarke, Callisia, Mogal, Harveshp, Maithel, Shishir K, Pawlik, Timothy M, D'Angelica, Michael I, Aloia, Thomas A, Eastwood, Daniel, Gamblin, T Clark (March 2021) Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: A Multi-institutional Analysis. Annals of Surgical Oncology, 28 (3). pp. 1457-1465. ISSN 1068-9265
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Abstract
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 hepatobiliary centers in the United States (US). METHODS: A retrospective review from five liver centers in the US 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 using an open technique (n = 194, 99.5%). The median number of tumors was 7 (range 2-33). One-hundred and 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 (OS) 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 OS as 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 complication 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). OS 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 US and demonstrates evidence of safety and feasibility in the management of bilateral CRLM. Outcomes are influenced by margin status and operative EBL.
| Item Type: | Paper |
|---|---|
| Subjects: | diseases & disorders > cancer diseases & disorders diseases & disorders > neoplasms diseases & disorders > cancer > cancer types > colon cancer diseases & disorders > cancer > cancer types > colon cancer diseases & disorders > cancer > cancer types > liver cancer diseases & disorders > cancer > metastasis diseases & disorders > cancer > cancer types |
| CSHL Authors: | |
| Communities: | CSHL labs > Gholami Lab |
| SWORD Depositor: | CSHL Elements |
| Depositing User: | CSHL Elements |
| Date: | March 2021 |
| Date Deposited: | 29 Sep 2023 20:00 |
| Last Modified: | 23 Jan 2024 19:04 |
| PMCID: | PMC8385606 |
| Related URLs: | |
| URI: | https://repository.cshl.edu/id/eprint/41089 |
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