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01-12-2012 | Original Article

A comparative study of patients with and without associated digestive surgery in a two-stage hepatectomy setting

Authors: Mattia Stella, Aurélien Dupre, Sylvie Chabaud, Alessandro Gandini, Pierre Meeus, Patrice Peyrat, Michel Rivoire

Published in: Langenbeck's Archives of Surgery | Issue 8/2012

Abstract

Purpose

The purpose of this study was to compare the feasibility and outcomes of two-stage hepatectomy in patients with or without accompanying digestive surgery.

Methods

We analyzed prospectively data from 56 patients with colorectal liver metastases undergoing two-stage hepatectomy between 1995 and 2009. Patients undergoing associated digestive resection (group I, n = 32) were compared with patients without associated digestive surgery (group II, n = 17).

Results

The feasibility rate was 87.5 % (49 patients). Neither the type and extent of hepatectomy nor the type of chemotherapy administered differed between the two groups. The median interval between hepatectomies was 1.79 and 2.07 months for groups I and II, respectively (not significant). One patient (group I) died of liver failure after the second hepatectomy. Postoperative morbidity rates were comparable: 37.5 % (group I) vs. 35.5 % (group II) after the first hepatectomy and 46.9 % (group I) vs. 52.9 % (group II) after the second hepatectomy. The median hospital stay after the first hepatectomy was longer in group I (13.5 days) than in group II (10 days) (P < 0.01). Median follow-up was 54 months. The median overall survival (OS) was 45.8 months, and 3- and 5-year OS were 58 and 31 %, respectively. Median OS was longer for group II (58 months) than for group I (34 months) (P = 0.048).

Conclusions

Digestive tract resection associated with two-stage hepatectomy does not increase postoperative mortality or morbidity nor does it lead to delay in chemotherapy or a reduction in cycles administered. The need for digestive tract surgery should not affect the surgical management of two-stage hepatectomy patients.

Wicherts DA, Miller R, de Haas RJ et al (2008) Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 248:994–1005PubMedCrossRef

Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef

Chun YS, Vauthey JN, Ribero D et al (2007) Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg 11:1498–1504, discussion 504-5PubMedCrossRef

Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785PubMedCrossRef

Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P (2004) 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 240:1037–1049, discussion 49-51PubMedCrossRef

Hillingso JG, Wille-Jorgensen P (2009) Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Color Dis 11:3–10CrossRef

Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, Polastri R (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14:195–201PubMedCrossRef

Karoui M, Vigano L, Goyer P et al (2010) Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases. Br J Surg 97:1354–1362PubMedCrossRef

Pang YY (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339, HPB (Oxford) 2002; 4:99

10.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef

11.

Aydin HN, Remzi FH, Tekkis PP, Fazio VW (2005) Hartmann's reversal is associated with high postoperative adverse events. Dis Colon Rectum 48:2117–2126PubMedCrossRef

12.

Kaiser AM, Israelit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G, Beart RW (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441PubMedCrossRef

13.

Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Yamaguchi T (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34:1937–1942PubMedCrossRef

14.

Tsim N, Healey AJ, Frampton AE et al (2011) Two-stage resection for bilobar colorectal liver metastases: R0 resection is the key. Ann Surg Oncol 18:1939–1946PubMedCrossRef

15.

Brouquet A, Abdalla EK, Kopetz S et al (2011) High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol 29:1083–1090PubMedCrossRef

16.

Martin RC 2nd, Augenstein V, Reuter NP, Scoggins CR, McMasters KM (2009) Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg 208:842–850, discussion 50-2PubMedCrossRef

17.

Martin R, Paty P, Fong Y et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241, discussion 41-2PubMedCrossRef

18.

Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200

19.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318, discussion 18-21PubMedCrossRef

Title: A comparative study of patients with and without associated digestive surgery in a two-stage hepatectomy setting
Authors: Mattia Stella
Aurélien Dupre
Sylvie Chabaud
Alessandro Gandini
Pierre Meeus
Patrice Peyrat
Michel Rivoire
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 8/2012
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1002-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparative study of patients with and without associated digestive surgery in a two-stage hepatectomy setting

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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