Chemotherapy Between the First and Second Stages of a Two-Stage Hepatectomy for Colorectal Liver Metastases: Should We Routinely Recommend It?
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The aim of the present study is to examine the effect of systemic chemotherapy after the 1st-stage hepatectomy (CT×2) on the progression of disease and dropout rates. A major pitfall of the 2-stage hepatectomy procedure is a high dropout rate after the 1st-stage hepatectomy due to progression of disease (PD). Routine use of CT×2 has been advocated.
A total of 47 patients with multiple, bilateral unresectable liver metastases were selected for a 2-stage hepatectomy procedure (±portal vein occlusion).
Of the total, 37 patients (78.7%) underwent systemic chemotherapy before the 1st-stage hepatectomy (CT×1) and 25 patients (53.2%) underwent CT×2; PD was significantly more common during CT×2 than during CT×1 (P = .002). Of the 47 patients planned for the 2nd-stage hepatectomy, 36 (76.6%) completed the procedure. Of these 47 patients, 25 (53.2%) showed PD after the 1st-stage hepatectomy, 12 in the CT×2 group and 13 in the no-CT×2 group; administration of CT×2 did not significantly affect the PD rate (P = .561). The overall dropout rate was 23.4% (n = 11 patients): 16% in the CT×2 group vs. 31.8% in the no-CT×2 group (P = .303).
The routine use of chemotherapy between the 1st- and 2nd-stage hepatectomy does not guarantee lower PD and dropout rates.
KeywordsBevacizumab Liver Metastasis Oxaliplatin Liver Resection Colorectal Liver Metastasis
- 2.Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240:1037–51.PubMedCrossRefGoogle Scholar
- 4.Pamecha V, Nedjat-Shokouhi B, Gurusamy K, Glantzounis GK, Sharma D, Davidson BR. Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolization and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases. Dig Surg. 2008;25:387–93.PubMedCrossRefGoogle Scholar
- 9.Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to treatment in solid tumours. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
- 14.Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. Effect of portal vein embolization on the growth rate of colorectal liver metastases. Br J Cancer. 2009;100:617–22.Google Scholar