Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

Abstract

Background Two-stage hepatectomy (TSH) has been proposed for patients with bilateral liver tumours who have a high risk of posthepatectomy liver failure after one-stage hepatectomy (OSH). This study aimed to determine the outcomes of TSH for extensive bilateral colorectal liver metastases. Patients and methods A retrospective review of a prospectively maintained database of liver resections for colorectal liver metastases was conducted. The TSH group was compared to the OSH group in terms of perioperative outcomes and survival. Case-control matching was performed. Results A total of 632 consecutive liver resections for colorectal liver metastases were performed between 2000 and 2020. The study group (TSH group) consisted of 15 patients who completed TSH. The control group included 151 patients who underwent OSH. The case-control matching-OSH group consisted of 14 patients. The major morbidity and 90-day mortality rates were 40% and 13.3% in the TSH group, 20.5% and 4.6% in the OSH group and 28.6% and 7.1% in the case-control matching-OSH group, respectively. The recurrence-free survival, median overall survival, and 3- and 5-year survival rates were 5 months, 21 months, 33% and 13% in the TSH group; 11 months, 35 months, 49% and 27% in the OSH group; and 8 months, 23 months, 36% and 21%, respectively, in the case-control matching-OSH group, respectively. Conclusions TSH used to be a favourable therapeutic choice in a select population of patients. Now, OSH should be preferred whenever feasible because it has lower morbidity and equivalent oncological outcomes to those of completed TSH.

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

“…The authors noted that their negative impact of obesity compared to other studies might be because 28% of patients underwent a major hepatectomy in their population, and more than half were in technically challenging locations, as opposed to the study by Yu et al in which most patients underwent a minor hepatectomy for mostly benign lesions [ 40 ]. In our study, 72.7% of patients in the obese group had a malignant lesion, and the rate of major hepatectomy was 25.0%, comparable to the population in the study of Chua et al [ 15 , 16 , 27 ].…”

Ranking as a Procedure for Selecting a Replacement Variable in the Score Predicting the Survival of Patients Treated with Curative Intent for Colorectal Liver Metastases

“…Our analysis ranked the multiplicity of the metastases group at sixth place. The risk of worse overall survival in the multiple metastases group was approximately 21% higher than in the solitary metastasis group (Table 2b), with a statistical significance close to <0.05, and the integral I S was 12.1 months [46]. The size of the largest colorectal liver metastasis was ≥3.3 cm, and it was ranked seventh, with a risk approximately 14% higher than that of the smaller colorectal liver metastases group (Table 2b).…”