Long-Term Results of Two-Stage Hepatectomy for Irresectable Colorectal Cancer Liver Metastases

被引:252
作者
Wicherts, Dennis A. [1 ,2 ]
Miller, Rafael [1 ,3 ]
de Haas, Robbert J. [1 ,2 ]
Bitsakou, Georgia [1 ]
Vibert, Eric [1 ]
Veilhan, Luc-Antoine [1 ]
Azoulay, Daniel [1 ]
Bismuth, Henri [1 ]
Castaing, Denis [1 ,4 ,5 ]
Adam, Rene [1 ,4 ,5 ]
机构
[1] Hop Paul Brousse, AP HP, Ctr Hepato Biliaire, F-94804 Villejuif, France
[2] Univ Med Ctr Utrecht, Dept Surg, Utrecht, Netherlands
[3] Rehovot & Hebrew Univ, Kaplan Med Ctr, Dept Surg, Jerusalem, Israel
[4] INSERM, F-75654 Paris 13, France
[5] Univ Paris Sud, Villejuif, France
关键词
D O I
10.1097/SLA.0b013e3181907fd9
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To assess feasibility, risks, and long-term outcome of 2-stage hepatectomy as a means to improve resectability of colorectal liver metastases (CLM). Summary Background Data: Two-stage hepatectomy uses compensatory liver regeneration after a first noncurative hepatectomy to enable a second curative resection. Methods: Between October 1992 and January 2007, among 262 patients with initially irresectable CLM, 59 patients (23%) were planned for 2-stage hepatectomy. Patients were eligible when single resection could not achieve complete treatment, even in combination with chemotherapy, portal embolization, or radiofrequency, but tumors could be totally removed by 2 sequential resections. Feasibility and outcomes were prospectively evaluated. Results: Two-stage hepatectomy was feasible in 41 of 59 patients (69%). Eighteen patients failed to complete the second hepatectomy because of disease progression (n = 17) or bad performance status (n = 1). The 41 successfully treated patients had a mean number of 9.1 metastases (mean diameter, 48.5 mm at diagnosis). Chemotherapy was delivered before (95%), in between (78%), and after (78%) the 2 hepatectomics. Mean delay between the 2 liver resections was 4.2 months. Postoperative mortality was 0% and 7% (3/41) after the first and second hepatectomy, respectively. Morbidity rates were also higher after the second procedure (59% vs. 20%) (P < 0.001). Five-year survival was 31% on an intention to treat basis, and all but 2 patients who did not complete the 2-stage strategy died within 19 months. After a median follow-up of 24.4 months (range, 3.7-130.3), overall 3- and 5-year survivals for patients that completed both hepatectomies were 60% and 42%, respectively, after the first hepatectomy (median survival, 42 months from first hepatectomy and 57 months from metastases diagnosis). Disease-free survivals were 26% and 13% at 3 and 5 years, respectively. Conclusions: Two-stage hepatectomy provides a 5-year survival of 42% and a hope of long-term survival for selected patients with extensive bilobar CLM, irresectable by any other means.
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页码:994 / 1005
页数:12
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