Two-stage hepatectomy versus 1-stage resection combined with radiofrequency for bilobar colorectal metastases: a case-matched analysis of surgical and oncological outcomes.

Abstract

The aim of this study was to compare the long-term results of 2 surgical strategies for patients with bilobar colorectal liver metastases (bCRLM). Two-stage hepatectomy is the surgical strategy mostly chosen for treating extensive BCLM with the pitfall of dropout after the first stage. One-stage strategy combining limited resections and radiofrequency ablation could be proposed as an option in this population. Between 2000 and 2010, 272 patients were consecutively operated in 2 expert centers practicing 1- or 2-stage hepatectomy for bCRLM. A case-match study (1:1) was conducted using number and size of nodules, synchronous presentation, primary node status, and extrahepatic disease as matching variables to compare overall survival (OS) and disease-free survival (DFS). The analysis was performed in intention to treat, including patients who did not undergo the second stage. In the case-match analysis (156 matched patients), median OS and DFS did not differ significantly between patients in 1- and 2-stage hepatectomy, respectively: 37.2 and 34.5 months (P=0.6), 9.4 and 7.5 months (P=0.25). Multivariate analysis confirmed the absence of impact of strategy on OS and DFS. Primary advanced T stage and synchronous presentation were predictors of poor OS (HR=3.67 and 1.92); CEA more than 200 ng/mL, absence of postoperative chemotherapy, and extrahepatic disease were predictive of recurrence (HR=2.77, 1.85 and 1.69, respectively). This first case-match study demonstrates that on an intention-to-treat analysis 1- and 2-stage hepatectomy in patients with bCRLM achieve comparable OS and DFS, despite the high dropout of the 2-stage strategy.