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

• Authors: Mariana I Chavez, Medical College of Wisconsin; Sepideh Gholami, Memorial Sloan Kettering Cancer Center; Bradford J Kim, MD Anderson Cancer Center, Houston; Georgios A Margonis, Johns Hopkins University; Cecillia G Ethun, Emory University; Susan Tsai, Medical College of Wisconsin; Kathleen K Christians, Medical College of Wisconsin; Callisia Clarke, Medical College of Wisconsin; Harveshp Mogal, Medical College of Wisconsin; Shishir Maithel, Emory University; Timothy M Pawlik, Ohio State University; Michael I D'Angelica, Memorial Sloan Kettering Cancer Center; Thomas A Aloia, Univ Texas MD Anderson Canc Ctr; Daniel Eastwood, Medical College of Wisconsin; Clark T Gamblin, Medical College of Wisconsin
• Journal Title: ANNALS OF SURGICAL ONCOLOGY
• Volume: Volume 28, Number 3
• Publisher: SPRINGER | 2021-01-03, Pages 1457-1465
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1245/s10434-020-09459-6
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; PORTAL-VEIN LIGATION; LONG-TERM OUTCOMES; RADIOFREQUENCY ABLATION; HEPATIC RESECTION; STAGED HEPATECTOMY; CANCER; SURVIVAL; RECURRENCE; PARTITION; STRATEGY

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.