Two-stage hepatectomy: Who will not jump over the second hurdle?

Turrini, Olivıer; Ewald, Jacques; Viret, F.; Sarran, Anthony; Gonçalves, A; Delpero, Jean‐Robert

doi:10.1016/j.ejso.2011.12.009

Cited by 41 publications

(45 citation statements)

References 16 publications

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“…These data were similar to those of completed TSH [5, 10, 11, 50, 51]. Of note, in an intention-to-treat perspective E-OSH showed better outcomes than TSH, even having enrolled 8% of patients who had progressed while on preoperative chemotherapy (Table 1).…”

Section: Discussionsupporting

confidence: 64%

“…However, the 2 groups were comparable in terms of metastases number and distribution. Second, TSH is a standardized procedure validated by different groups [5, 10, 11, 14, 15, 37, 38, 50, 51], while E-OSH not yet. At the HRH center, E-OSH is commonly performed by all the staff surgeons, but its reproducibility and learning curve remain to be assessed and require external validation.…”

Section: Discussionmentioning

confidence: 99%

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Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers

et al. 2018

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Background: Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal metastases (CLM). As alternative, ultrasound-guided one-stage hepatectomy (E-OSH) has been proposed even for deep-located nodules to compare TSH and E-OSH. Methods: All consecutive TSH at the Paul Brousse Hospital and E-OSH at the Humanitas Research Hospital were considered. The inclusion criteria were ≥6 CLM, ≥3 CLM in the left liver, and ≥1 lesion with vascular contact. A total of 74 TSH and 35 E-OSH were compared. Results: The 2 groups had similar characteristics. Drop-out rate of TSH was 40.5%. In comparison with the cumulated hepatectomies of TSH, E-OSH had lower blood loss (500 vs. 1,100 mL, p = 0.009), overall morbidity (37.1 vs. 70.5%, p = 0.003), severe morbidity (14.3 vs. 36.4%, p = 0.04), and liver-specific morbidity (22.9 vs. 40.9%, p = 0.02). R0 resection rate was similar between groups. E-OSH and completed TSH had similar overall survival (5-year 38.2 vs. 31.8%), recurrence-free survival (3-year 17.6 vs. 17.7%), and recurrence sites. Conclusions: E-OSH is a safe alternative to TSH for multiple bilobar deep-located CLM. Whenever feasible, E-OSH should even be considered the preferred option because it has excellent safety and oncological outcomes equivalent to completed TSH, without the drop-out risk.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers

et al. 2018

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“…Previously reported 5-year overall survival (OS) rates after completion of TSH ranged from 32% to 64%, with median survival times of 24-44 months [1,[3][4][5][6][7][8][9][10][11][12]19,20]. Preoperative chemotherapy cycles ≥6 [10], tumor number ≥6 [1], the presence of concomitant extrahepatic disease [1], and no postoperative chemotherapy [1] were reported to be independent prognostic factors of poor survival after completion of TSH.…”

Section: Resultsmentioning

confidence: 99%

“…Some independent predictive factors of dropout have been proposed: CLM number in the FRL ≥3 [19], age ≥70 years [19], combined resection of primary tumor [20], and disease progression during chemotherapy [10]. Recently, a predictive score was proposed that includes preoperative carcinoembryonic antigen >30 ng/ml, tumor size >40 mm, preoperative chemotherapy cycles >12, and disease progression during first-line chemotherapy [12].…”

Section: Resultsmentioning

confidence: 99%

Surgery of Colorectal Liver Metastases: Pushing the Limits

et al. 2016

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Background: The recent advent of more effective chemotherapy and the development of surgical procedures have expanded the pool of resectable patients with colorectal liver metastases (CLM). Two-stage hepatectomy (TSH), associated liver partition and portal vein ligation for staged hepatectomy (ALPPS), and ultrasound-guided enhanced one-stage hepatectomy (e-OSH) are the surgical solutions proposed for these patients, but the range of indications for these procedures vary from institution to institution. Summary: The advantages and disadvantages of each approach are herein discussed. Patients who drop out between the staged operations of TSH limit its success rate, although predictive scores may help with patient selection and thereby optimize the results. Safety and oncological suitability are concerns to be addressed when considering ALPPS. These concerns notwithstanding, ALPPS has introduced an innovative concept in surgery: the monosegmental remnant liver. Studies involving e-OSH have proven the oncological suitability of tumor exposure once the CLM is detached from major intrahepatic vessels. This finding could expand the indications for e-OSH, although the technical challenges that it entails limit its spread among the surgical community. The liver-first approach involves the clearance of tumors from the liver before the colorectal primary is tackled. This approach fully justifies the complexity of e-OSH. Key Messages: Predictive scores limiting the interstage dropout of TSH, partial and monosegmental ALPPS, and R1 vascular e-OSH justified by solid long-term results represent new insights that could help refne the patient assignment to each of these approaches. Additionally, liver transplantation is an emerging treatment for CLM that should be taken into account.

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“…In fact, in the literature as in the present study, patients who did not complete TSH had extremely unfavourable prognoses. 29,30 However, the progression between the two stages of TSH occurs in peculiar conditions. The liver hypertrophy induced by the first stage and by the PVO could enhance neoplastic proliferation and progression.…”

Section: Discussionmentioning

confidence: 98%