Two-Stage Hepatectomy vs One-Stage Major Hepatectomy with Contralateral Resection or Ablation for Advanced Bilobar Colorectal Liver Metastases.

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Two-Stage Hepatectomy vs One-Stage Major Hepatectomy with Contralateral Resection or Ablation for Advanced Bilobar Colorectal Liver Metastases.

J Am Coll Surg. 2018 Feb 14;:

Authors: Mizuno T, Cloyd JM, Omichi K, Chun YS, Conrad C, Tzeng CD, Wei SH, Aloia TA, Vauthey JN

Abstract
BACKGROUND: Both two-stage hepatectomy (TSH) and one-stage hepatectomy (OSH) represent feasible strategies for resection of advanced bilobar colorectal liver metastases (CLM). However, the influence of the surgical approach on postoperative outcomes and overall survival (OS) is unknown. To define the optimal surgical approach for advanced bilobar CLM requiring right hemihepatectomy, we compared short-term and long-term outcomes following TSH and OSH with contralateral resection or radiofrequency ablation (RFA).
METHODS: A total of 227 patients with bilobar CLM who underwent right or extended right hepatectomy with treatment of synchronous CLM in segments I, II, and/or III during 1998-2015 were retrospectively reviewed. Postoperative outcomes and OS were compared between patients who underwent TSH and those who underwent OSH.
RESULTS: Of the 227 patients, 126 (56%) underwent at least the first stage of TSH, and 101 (44%) underwent OSH, 29 (13%) without RFA and 72 (32%) with RFA. TSH was associated with a lower incidence of postoperative major complications (14% vs 26%, p=0.03) and postoperative hepatic insufficiency (6% vs 20%, p=0.001) than OSH. The 5-year OS rate was higher for patients assigned to TSH than for those who underwent OSH (35% vs 24%, p=0.016). Patients who completed both stages of TSH had a higher 5-year OS rate than patients who underwent OSH without RFA (50% vs 20%, p=0.023) or OSH with RFA (50% vs 24%, p<0.0001).
CONCLUSION: In patients with advanced bilobar CLM, TSH is associated with fewer complications than OSH. Both TSH in intention-to-treat analysis and completed TSH in as-treated analysis were associated with better OS than OSH.

PMID: 29454099 [PubMed - as supplied by publisher]

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