Two-stage hepatectomy in resection of bilobar colorectal liver metastases: surgical outcomes and prognostic factors
Mykytyuk A., Burlaka A., Lukashenko A., Beznosenko A., Rozhkova V., Shchebetun A., Bankovska N.
Summary. According to the World Health Organization, colorectal cancer (CRC) occupies the third place worldwide among malignant neoplasms detection frequency. About 43% of the population face distant metastatic disease, which is the main cause of death. Two-stage hepatectomy (TSH) is an effective method of surgical treatment of bilobar colorectal liver metastasis. To avoid postoperative liver failure we use TSH to induct hypertrophy of the future liver remnant. The purpose of our analysis was to assess perioperative and long-term results of TSH in case of metastatic bilobar lesions of CRC in high volume center. Materials and methods. The retrospective analysis of a prospectively maintained database of 480 patients using the National Cancer Registry was conducted. Data collection was carried out from January 1, 2015, to April 1, 2024. Standard demographic and clinicopathological data were analyzed, including sex, age, initial diagnosis information, neoadjuvant therapy, and primary tumor characteristics. Surgical and oncological outcomes was done with case-control matching approach. TSH inclusion criteria were multiple verified bilobar liver colorectal metastasis, completed two-stage liver resection (TSLR), total liver lesions removal, and achievement of referent volume of future liver remnant (FLR). Results. According to the inclusion criteria, 45 patients were included, but 4 of them dropped out due to disease progression (7.2%) and mortality rate after the first stage of surgical treatment was (2.4%). The mortality rate on the 90th day after the second stage of liver resection was 24.4%. The median follow-up for all patients was 28 months (1–96 months). The 5-year overall survival (OS) rate was 37±12%, with a median survival of 30±6 months. Cumulative 5-year disease-free survival (DFS) was 21±5%. Meanwhile, 9.7% were unable to complete the second surgical intervention and were classified in the «drop-out» cohort and did not survive the 5-year period. Conclusions. Two-stage hepatectomy provide satisfactory oncological outcomes for patients with bilobar liver metastasis. The implementation of this technique at the National Cancer Institute has improved 5-year survival rates that are comparable with worldwide rates. We believe that a multidisciplinary approach to utilizing a two-stage surgical strategy for bilobar colorectal liver metastasis is a safe method modern liver surgery standards are adhered to.
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