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Two-Stage Resection for Bilobar Colorectal Liver Metastases: R0 Resection Is the Key

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Two-stage liver resection (2-SLR) is used clinically in conjunction with portal vein embolization for bilobar disease to increase the number of patients suitable for liver resection. The long-term outcomes after 2-SLR for multiple bilobar colorectal liver metastases (CLM) was examined.

Methods

Patients who sought care between November 2003 and April 2006 with multiple CLM considered suitable for 2-SLR were prospectively followed. Clinicopathological data were collected. Surgical outcomes were defined as complete clearance of tumor (R0/R1/R2), postoperative morbidity (within 3 months), 30 day mortality, disease-free survival (DFS), and overall survival (OS).

Results

A total of 131 patients with CLM underwent liver resection during the study period, 38 of whom were planned for a 2-SLR for multiple bilobar disease. Only 33 (87%) completed the 2-SLR with a curative intent. Five patients did not undergo stage II resection because of disease progression. The postoperative morbidity was 11 and 33% after stage I and stage II liver resections, respectively. Five patients (13%) encountered postoperative complications specific to liver surgery. The median interval from stage II resection to disease recurrence in the R0 group was 18 months versus 3 months in the R1/R2 group (P < 0.001). R0 resection with curative intent versus R1/R2 noncurative resection has a significantly longer period of DFS (P < 0.001) and OS (P = 0.04).

Conclusions

The 2-SLR combined with portal vein embolization is an effective and safe method for resecting previously unresectable multiple bilobar CLM. However, a positive resection margin leads to poor DFS and OS.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery and Cancer, HPB Surgical Unit, Imperial College, Hammersmith Hospital Campus, London, UK

    Nicole Tsim MRCS, Andrew J. Healey MRCS(Ed), Adam E. Frampton MRCS, Nagy A. Habib ChM, FRCS & Long R. Jiao MD, FRCS

  2. Department of Gastroenterology, Imperial College NHS Trust, Hammersmith Hospital, London, UK

    Devinder S. Bansi BM, DM, FRCP

  3. Department of Oncology, Imperial College, Hammersmith Hospital Campus, London, UK

    Harpreet Wasan MBBS, MRCP, PhD, Susan J. Cleator BA, PhD, MRCP, FRCR, Justin Stebbing PhD, FRCP & Charles P. Lowdell MD, BSc, MBBS, FRCP, FRCR

  4. Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, London, UK

    James E. Jackson BM BS, MRCP, FRCR & Paul Tait MA, FRCR

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  1. Nicole Tsim MRCS
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  2. Andrew J. Healey MRCS(Ed)
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  9. Charles P. Lowdell MD, BSc, MBBS, FRCP, FRCR
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  12. Long R. Jiao MD, FRCS
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Correspondence to Long R. Jiao MD, FRCS.

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Tsim, N., Healey, A.J., Frampton, A.E. et al. Two-Stage Resection for Bilobar Colorectal Liver Metastases: R0 Resection Is the Key. Ann Surg Oncol 18, 1939–1946 (2011). https://doi.org/10.1245/s10434-010-1533-y

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  • DOI: https://doi.org/10.1245/s10434-010-1533-y

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