Annals of Surgical Oncology

, Volume 19, Issue 4, pp 1310–1315 | Cite as

Chemotherapy Between the First and Second Stages of a Two-Stage Hepatectomy for Colorectal Liver Metastases: Should We Routinely Recommend It?

  • Andrea Muratore
  • Giuseppe Zimmitti
  • Dario Ribero
  • Alfredo Mellano
  • Luca Viganò
  • Lorenzo Capussotti
Hepatobiliary Tumors



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.


Bevacizumab Liver Metastasis Oxaliplatin Liver Resection Colorectal Liver Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Muratore A, Ribero D, Zimmitti G, Mellano A, Langella S, Capussotti L. Resection margin and recurrence-free survival after liver resection of colorectal metastases. Ann Surg Oncol. 2010;17:1324–9.PubMedCrossRefGoogle Scholar
  2. 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
  3. 3.
    Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248:994–1005.PubMedCrossRefGoogle Scholar
  4. 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
  5. 5.
    Tsai S, Marques HP, de Jong MC, Mira P, Ribeiro V, Schulick RD, et al. Two-stage strategy for patients with extensive bilateral colorectal liver metastases. HPB (Oxford). 2010;12:262–9.CrossRefGoogle Scholar
  6. 6.
    Kollmar O, Corsten M, Scheuer C, Vollmar B, Schilling MK, Menger MD. Tumour growth following portal branch ligation in an experimental model of liver metastases. Br J Surg. 2010;97:917–26.PubMedCrossRefGoogle Scholar
  7. 7.
    Meredith K, Haemmerich D, Qi C, Mahvi D. Hepatic resection but not radiofrequency ablation results in tumor growth and increased growth factor expression. Ann Surg. 2007;245:771–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Karoui M, Vigano L, Goyer P, Ferrero A, Luciani A, Aglietta M, et al. Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases. Br J Surg. 2010;97:1354–62.PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg. 2006;93;1001–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Capussotti L, Muratore A, Baracchi F, Lelong B, Ferrero A, Regge D, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg. 2008;143:978–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Ferrero A, Viganò L, Polastri R, Muratore A, Eminefendic H, Regge D, et al. Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg. 2007;31;1643–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Adam R, Laurent A, Azoulay D, Castaing D., Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    White RR, Schwartz LH, Munoz JA, Raggio G, Jarnagin WR, Fong Y, et al. Assessing the optimal duration of chemotherapy in patients with colorectal liver metastases. J Surg Oncol. 2008;97:601–4.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Andrea Muratore
    • 1
  • Giuseppe Zimmitti
    • 2
  • Dario Ribero
    • 2
  • Alfredo Mellano
    • 1
  • Luca Viganò
    • 2
  • Lorenzo Capussotti
    • 2
  1. 1.Department of Surgical OncologyIstituto per la Ricerca e la Cura del CancroCandioloItaly
  2. 2.Department of Digestive and Hepatobiliary-SurgeryOspedale Mauriziano “Umberto I”TurinItaly

Personalised recommendations