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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Mariana I. Chavez MD, Susan Tsai MD, MHS, Kathleen K. Christians MD, Callisia Clarke MD, MS, Harveshp Mogal MD, MS & T. Clark Gamblin MD, MS, MBA, FACS

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sepideh Gholami MD & Michael I. D’Angelica MD

  3. MD Anderson Cancer Center, Houston, TX, USA

    Bradford J. Kim MD & Thomas A. Aloia MD

  4. Johns Hopkins University, Baltimore, MD, USA

    Georgios A. Margonis MD

  5. Emory University, Atlanta, GA, USA

    Cecilia G. Ethun MD & Shishir K. Maithel MD

  6. The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik MD, PhD, MPH

  7. Division of Biostatistics at Medical College of Wisconsin, Milwaukee, WI, USA

    Daniel Eastwood MS

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  1. Mariana I. Chavez MD
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Corresponding author

Correspondence to T. Clark Gamblin MD, MS, MBA, FACS.

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Disclosures

Mariana I. Chavez, Sepideh Gholami, Bradford J. Kim, Georgios A. Margonis, Cecilia G. Ethun, Susan Tsai, Kathleen K. Christians, Callisia Clarke, Harveshp Mogal, Shishir K. Maithel, Timothy M. Pawlik, Michael I. D’Angelica, Thomas A. Aloia, Daniel Eastwood, and T. Clark Gamblin declare they have no conflicts of interest or financial disclosures.

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Chavez, M.I., Gholami, S., Kim, B.J. et al. Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: A Multi-institutional Analysis. Ann Surg Oncol 28, 1457–1465 (2021). https://doi.org/10.1245/s10434-020-09459-6

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  • DOI: https://doi.org/10.1245/s10434-020-09459-6

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