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Two-stage hepatectomy, a 10 years experience

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Abstract

Colorectal tumor represents in Europe the second most common cause of cancer death. Surgical resection in case of colorectal liver metastasis remain for patients the only cure. In 2003, Jaeck et al. described a one or two-stage hepatectomy combined with PVE for initially non-resectable colorectal liver metastases. The aim of our study was to retrospectively review all patients who underwent to a two-stage hepatectomy for CLM and evaluate the safety and feasibility of the procedure. We review all patient who underwent two-stage hepatectomy for CLM in our center. From 2004 to March 2014, 57 patients were candidate for a two-stage hepatectomy for CLM. Thirty-two patients (55.9 %) were men and twenty-five women (44.1 %). Median age was 60.9 years old. In forty-six cases, the two-stage hepatectomy was completed. Of these 46 patients, 38 patients completed the procedure with a PVL and 8 underwent a secondary PVE. Seven patients were planned but did not performed PVL after intraoperative evaluation and neither PVE after secondary evaluation due to disease progression. Five cases were treated with a laparoscopic approach for the first step procedure. We had no death in this series. Ten patients developed complications after the first-stage operation and 18 patients had complications after the second stage. The median interval between the two stages was 66 days. Long-term overall survival was 52 months from the first liver surgery. This study demonstrated the feasibility of two-stage hepatectomy without postoperative mortality. In our last experience in selected patient, a laparoscopic first step should be performed. Patients selection is extremely important to propose the best therapeutic option for each one.

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References

  1. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30

    Article  PubMed  Google Scholar 

  2. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247(1):125–135

    Article  PubMed  Google Scholar 

  3. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer 77(7):1254–1262

    Article  CAS  PubMed  Google Scholar 

  4. 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(6):777–785

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, Greget M (2003) One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg 185(3):221–229

    Article  PubMed  Google Scholar 

  6. Abulkhir A et al (2008) Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 247:49–57

    Article  PubMed  Google Scholar 

  7. Narita M, Oussoultzoglou E, Jaeck D, Fuchschuber P, Rosso E, Pessaux P, Marzano E, Bachellier P (2011) Two-stage hepatectomy for multiple bilobar colorectal liver metastases. Br J Surg 98(10):1463–1475. doi:10.1002/bjs.7580

    Article  CAS  PubMed  Google Scholar 

  8. Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, Soubrane O, Schnitzbauer AA, Raptis D, Tschuor C, Petrowsky H, De Santibanes E, Clavien PA, ALPPS Registry Group (2014) Early survival and safety of ALPPS: First Report of the International ALPPS Registry. Ann Surg. 260(5):829–838. doi:10.1097/SLA.0000000000000947

    Article  PubMed  Google Scholar 

  9. Meniconi RL, Ettorre GM, Vennarecci G, Lepiane P, Colasanti M, Laurenzi A, Colace L, Santoro R (2013) Use of cold-stored vein allografts for venous reconstruction during pancreaticoduodenectomy. J Gastrointest Surg 17(7):1233–1239. doi:10.1007/s11605-013-2201-x

    Article  PubMed  Google Scholar 

  10. Levi Sandri GB, Colace L, Vennarecci G, Santoro R, Lepiane P, Colasanti M, Burocchi M, Ettorre GM (2015) Laparoscopic first step approach in the two stage hepatectomy. Hepatobiliary Surg Nutr. doi:10.3978/j.issn.2304-3881.2015.01.13

    Google Scholar 

  11. Ettorre GM, Douard R, Corazza V, Santoro R, Vennarecci G, Santoro E (2007) Anatomical basis of liver hanging maneuver: a clinical and anatomical in vivo study. Am Surg 73(11):1193–1196

    PubMed  Google Scholar 

  12. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghémard O, Levi F, Bismuth H (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 240(4):644–657 discussion 657–8

    PubMed Central  PubMed  Google Scholar 

  13. Masi G, Cupini S, Marcucci L, Cerri E, Loupakis F, Allegrini G, Brunetti IM, Pfanner E, Viti M, Goletti O, Filipponi F, Falcone A (2006) Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer. Ann Surg Oncol 13(1):58–65

    Article  PubMed  Google Scholar 

  14. Jaeck D, Oussoultzoglou E, Rosso E et al (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 240:1037–1051

    Article  PubMed Central  PubMed  Google Scholar 

  15. Tanaka K, Shimada H, Matsuo K et al (2007) Remnant liver regeneration after two-stage hepatectomy for multiple bilobar colorectal metastases. Eur J Surg Oncol 33:329–335

    Article  CAS  PubMed  Google Scholar 

  16. Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, Azoulay D, Bismuth H, Castaing D, Adam R (2008) Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 248(6):994–1005. doi:10.1097/SLA.0b013e3181907fd9

    Article  PubMed  Google Scholar 

  17. Zimmitti G, Roses RE, Andreou A et al (2013) Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except bile leak: an experience with 2628 consecutive resections. J Gastrointest Surg 17:57–64

    Article  PubMed  Google Scholar 

  18. Garufi C, Torsello A, Tumolo S, Ettorre GM, Zeuli M, Campanella C, Vennarecci G, Mottolese M, Sperduti I, Cognetti F (2010) Cetuximab plus chronomodulated irinotecan, 5-fluorouracil, leucovorin and oxaliplatin as neoadjuvant chemotherapy in colorectal liver metastases: POCHER trial. Br J Cancer 103(10):1542–1547. doi:10.1038/sj.bjc.6605940

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Di Fabio F, Whistance R, Rahman S, Primrose JN, Pearce NW, Abu Hilal M (2012) Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases. J Laparoendosc Adv Surg Tech A 22(7):647–650. doi:10.1089/lap.2012.0163

    Article  PubMed  Google Scholar 

  20. Are C, Iacovitti S, Prete F, Crafa FM (2008) Feasibility of laparoscopic portal vein ligation prior to major hepatectomy. HPB (Oxford) 10(4):229–233. doi:10.1080/13651820802175261

    Article  CAS  Google Scholar 

  21. Vennarecci G, Ettorre GM, Lorusso R, Santoro R, Visco G, Santoro E (2007) Surgical prospects for liver metastases. Chir Ital 59(1):27–39

    PubMed  Google Scholar 

  22. Faitot F, Soubrane O, Wendum D, Sandrini J, Afchain P, Balladur P, de Gramont A, Scatton O (2014) Feasibility and survival of two-stage hepatectomy for colorectal metastases: definition of a simple and early clinico-pathological predicting score. Surgery. doi:10.1016/j.surg.2014.09.033

    PubMed  Google Scholar 

  23. Abbott DE, Sohn VY, Hanseman D, Curley SA (2014) Cost-effectiveness of simultaneous resection and RFA versus 2-stage hepatectomy for bilobar colorectal liver metastases. J Surg Oncol 109(6):516–520. doi:10.1002/jso.23539

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00151, Rome, Lazio, Italy

    Giovanni Battista Levi Sandri, Roberto Santoro, Giovanni Vennarecci, Pasquale Lepiane, Marco Colasanti & Giuseppe Maria Ettorre

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  1. Giovanni Battista Levi Sandri
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  2. Roberto Santoro
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  3. Giovanni Vennarecci
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  4. Pasquale Lepiane
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  5. Marco Colasanti
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  6. Giuseppe Maria Ettorre
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Correspondence to Giovanni Battista Levi Sandri.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

Only human participants were engaged in our study protocol. No animals were enrolled.

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Informed consent was obtained from all individual participants included in the study.

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Levi Sandri, G.B., Santoro, R., Vennarecci, G. et al. Two-stage hepatectomy, a 10 years experience. Updates Surg 67, 401–405 (2015). https://doi.org/10.1007/s13304-015-0332-1

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  • DOI: https://doi.org/10.1007/s13304-015-0332-1

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