Background: The surgery for the treatment of multiple (> or =5) bi-lobar hepatic metastases from colorectal cancer is controversial. This retrospective study presents our experience in an attempt to develop reasonable treatment guidelines.
Method: One hundred sixty-one consecutive patients who underwent liver resection with curative intent were classified into three groups: H1 (unilateral), H2 (bilateral, < or =4 nodules), or H3 (bilateral, > or =5 nodules).
Results: The overall cumulative 5-year survival rate was 46.7%. Survival was similar among patients with H1, H2, and H3 disease. Thirty-two patients with H3 disease underwent hepatectomy: straightforward hepatectomy in 12, portal vein embolization (PVE) prior to hepatectomy in eight, two-stage hepatectomy in two, and two-stage hepatectomy combined with PVE in ten. Two-stage hepatectomy with or without PVE was the standard approach in patients with synchronous liver metastases. The operating mortality in hepatectomy for H3 disease was 0%, and the morbidity was 15.2%. The overall response rate to neoadjuvant chemotherapy (NAC) was 41.7% (5/12). Patients who responded to NAC (n=5) had a better prognosis than non-responders (n=7) ( P<0.05).
Conclusions: Extended hepatectomy, including preoperative PVE and multi-step hepatectomy, combined with NAC, may result in a favourable prognosis, especially in patients who respond to NAC, but further studies with more patients are needed to confirm this.
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Article Synopsis
- Multimodal two-stage hepatectomy (mTSH) is a surgical approach for patients with bilobar colorectal liver metastases (CRLM) who can't be treated with a single operation due to limited liver function.
- A narrative review of clinical studies shows that interval chemotherapy is used in mTSH and might improve disease control, though only a few studies have specifically reported its effects.
- Current data suggest that interval chemotherapy does not negatively impact liver growth during mTSH or lead to serious complications, but more randomized clinical trials are needed for definitive conclusions.
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