• J. Am. Coll. Surg. · May 2018

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

    • Takashi Mizuno, Jordan M Cloyd, Kiyohiko Omichi, Yun Shin Chun, Claudius Conrad, Tzeng Ching-Wei D CD Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Steven H Wei, Thomas A Aloia, and Jean-Nicolas Vauthey.
    • Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
    • J. Am. Coll. Surg. 2018 May 1; 226 (5): 825-834.

    BackgroundBoth 2-stage hepatectomy (TSH) and 1-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 after TSH and OSH with contralateral resection or radiofrequency ablation (RFA).Study DesignWe retrospectively reviewed 227 patients with bilobar CLM, who underwent right or extended right hepatectomy with treatment of synchronous CLM in segments I, II, and/or III, between 1998 and 2015. Postoperative outcomes and OS were compared between patients who underwent TSH and those who underwent OSH.ResultsOf 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. Two-stage hepatectomy 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).ConclusionsIn 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.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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