BACKGROUND: Surgical resection is associated with improved long-term survival in patients with colorectal liver metastases (CLM). However, majority of patients have unresectable bilobar advanced liver metastases. Two-stage resection (TSR) allows selected patients to achieve complete resection when combined with chemotherapy and interventional radiological procedures. METHODS: Electronic search of the MEDLINE and PubMed databases (January 2000-October 2011) to identify studies examining the outcomes of the surgical approach of TSR of advanced CLM was undertaken. RESULTS: Twelve studies were examined. This comprised 488 patients. A median of 77% (range: 64-100%) of planned patients completed TSR. The most common reason for failure was due to disease progression observed in a median of 100% (range: 56-100%) of patients. Second-stage resection appeared to be more morbid compared to first-stage resection with higher complication rates (33% vs. 14%) and requiring more blood transfusions (3 U vs. 1 U). Completed TSR achieved a median survival of 37 (range: 18-66) months, median 3-year survival rate of 60% (range: 45-84%), and median 5-year survival rate of 48% (range: 32-70%). In patients who failed TSR, the median survival was 16 (range: 10-29) months. CONCLUSION: In carefully selected candidates with advanced bilobar CLM, the TSR approach achieves long-term survival in patients who would otherwise be considered for palliative chemotherapy only. Despite failing to complete TSR, patients had an encouraging survival outcome that appeared to compare favorably over palliative chemotherapy alone.
BACKGROUND: Surgical resection is associated with improved long-term survival in patients with colorectal liver metastases (CLM). However, majority of patients have unresectable bilobar advanced liver metastases. Two-stage resection (TSR) allows selected patients to achieve complete resection when combined with chemotherapy and interventional radiological procedures. METHODS: Electronic search of the MEDLINE and PubMed databases (January 2000-October 2011) to identify studies examining the outcomes of the surgical approach of TSR of advanced CLM was undertaken. RESULTS: Twelve studies were examined. This comprised 488 patients. A median of 77% (range: 64-100%) of planned patients completed TSR. The most common reason for failure was due to disease progression observed in a median of 100% (range: 56-100%) of patients. Second-stage resection appeared to be more morbid compared to first-stage resection with higher complication rates (33% vs. 14%) and requiring more blood transfusions (3 U vs. 1 U). Completed TSR achieved a median survival of 37 (range: 18-66) months, median 3-year survival rate of 60% (range: 45-84%), and median 5-year survival rate of 48% (range: 32-70%). In patients who failed TSR, the median survival was 16 (range: 10-29) months. CONCLUSION: In carefully selected candidates with advanced bilobar CLM, the TSR approach achieves long-term survival in patients who would otherwise be considered for palliative chemotherapy only. Despite failing to complete TSR, patients had an encouraging survival outcome that appeared to compare favorably over palliative chemotherapy alone.
Authors: Sven A Lang; Martin Loss; Volker Benseler; Gabriel Glockzin; Hans J Schlitt Journal: Langenbecks Arch Surg Date: 2015-02-18 Impact factor: 3.445
Authors: Yoshihiro Mise; Thomas A Aloia; Claudius Conrad; Steven Y Huang; Michael J Wallace; Jean-Nicolas Vauthey Journal: J Gastrointest Surg Date: 2014-08-05 Impact factor: 3.452
Authors: Vincent W T Lam; Jerome M Laurence; Emma Johnston; Michael J Hollands; Henry C C Pleass; Arthur J Richardson Journal: HPB (Oxford) Date: 2012-11-07 Impact factor: 3.647
Authors: Guido Torzilli; René Adam; Luca Viganò; Katsunori Imai; Jeremias Goransky; Andrea Fontana; Christian Toso; Pietro Majno; Eduardo de Santibañes Journal: Liver Cancer Date: 2016-11-29 Impact factor: 11.740