scholarly journals Two-stage hepatectomy for colorectal liver metastases: Pathologic response to preoperative chemotherapy is associated with second-stage completion and longer survival

Surgery ◽  
2019 ◽  
Vol 165 (4) ◽  
pp. 703-711 ◽  
Author(s):  
François Quénet ◽  
Marie-Hélène Pissas ◽  
Hugo Gil ◽  
Lise Roca ◽  
Sébastien Carrère ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Pathologic Response ◽  
Two Stage ◽  
Second Stage

Complete Pathologic Response After Preoperative Chemotherapy for Colorectal Liver Metastases: Myth or Reality?

2008 ◽  
Vol 26 (10) ◽  
pp. 1635-1641 ◽  
Author(s):  
René Adam ◽  
Dennis A. Wicherts ◽  
Robbert J. de Haas ◽  
Thomas Aloia ◽  
Francis Lévi ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Predictive Factors ◽  
Colorectal Liver Metastases ◽  
Objective Response ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Pathologic Response ◽  
High Survival ◽  
Complete Pathologic Response

Purpose Complete clinical response (CCR) of colorectal liver metastases (CLM) following chemotherapy is of limited predictive value for complete pathologic response (CPR) and cure of the disease. The objective of this study was to determine predictive factors of CPR as well as its impact on survival. Patients and Methods From January 1985 to July 2006, 767 consecutive patients with CLM underwent liver resection after systemic chemotherapy. Patients with CPR were compared with patients without CPR. Results Twenty-nine of 767 (4%) patients had CPR, and none of these 29 patients had CCR. Patients with CPR (mean age, 54 years) had a mean number of 3.3 metastases at diagnosis (mean size, 29.3 mm). Objective response and stable disease were observed in 79% and 21% of cases, respectively. Postoperative mortality rate was 0%. After a median follow-up of 52.2 months (range, 1.1 to 193.0 months), overall 5-year survival was 76% for patients with CPR compared with 45% for patients without CPR (P = .004). Independent predictive factors for CPR were: age ≤ 60 years, size of metastases ≤ 3 cm at diagnosis, carcinoembryonic antigen (CEA) level at diagnosis ≤ 30 ng/mL, and objective response following chemotherapy. The probability of CPR ranged from 0.2% when all factors were absent to 30.9% when all were present. Conclusion CPR was observed in 4% of patients with CLM treated with preoperative chemotherapy. However, CPR may occur in almost one-third of objective responders age ≤ 60 years with metastases ≤ 3 cm and low CEA values. CPR is associated with uncommon high survival rates.

Two-stage hepatectomy for colorectal metastases: Association of a good pathologic response to intensified preoperative chemotherapy with second stage completion and longer survival.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 666-666
Author(s):  
François Quenet ◽  
Marie-Hélène Pissas ◽  
Hugo Gil ◽  
Lise Roca ◽  
Sebastien Carrere ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Predictive Factors ◽  
Pathologic Response ◽  
Drop Out ◽  
Colorectal Metastases ◽  
Tumour Regression ◽  
Two Stage ◽  
Term Survival ◽  
Tumour Regression Grade ◽  
Second Stage

666 Background: The two-stage surgical resection (TSR) of bilobar colorectal liver metastases (CRLM) is widely used and has shown encouraging survival results. The risk of drop-out after the first-stage hepatectomy remains high and associated with poor survival rates. Our objective was to evaluate the predictive factors of long-term survival, based on the pathologic response to an intensified systemic chemotherapy administered preoperatively. Methods: Data from 899 patients treated for CRLM in our institution were collected prospectively between January 2003 and August 2013. We evaluated the pathologic response to preoperative chemotherapy, and its impact on the second-stage completion and on survival. Results: Sixty-seven patients were eligible for the TSR first stage. All patients underwent an intensified chemotherapy in combination with a biotherapy (Bevacizumab or Cetuximab) in 38cases. The Tumour Regression Grade (TRG), the Blazer grade, and the modified-TRG were used to classify patients as responders (TRG and mTRG 1-3, Blazer 0-1) or non-responders (TRG and mTRG 4-5, Blazer 2) after the first stage. Responders in the three classifications (TRG: p = 0.033; mTRG: p = 0.03, Blazer:p = 0.005), and initial metastases number (p = 0.001) were independent predictive factors for the second-stage completion. Triple chemotherapy were associated with responders in the three classifications (TRG and mTRG: 73.7% versus 26.3% p < 0.0001 ; Blazer : 84.2% versus 15.8% p = 0.001). Median overall survival (OS) of patients who completed TSR was significantly different (44, 84 versus18,39 months; p < 0.0001). There was no statistical difference in OS and recurrence-free survival between the responders and non-responders. Conclusions: A good pathologic response to intensified preoperative chemotherapy is associated with completion of the second stage of TSR, and thus with a longer survival. Knowing this response before the first-stage resection may allow avoiding useless resections for patients who will not benefit from this strategy.

scholarly journals High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

2011 ◽  
Vol 29 (8) ◽  
pp. 1083-1090 ◽  
Author(s):  
Antoine Brouquet ◽  
Eddie K. Abdalla ◽  
Scott Kopetz ◽  
Christopher R. Garrett ◽  
Michael J. Overman ◽  
...  
Keyword(s):  
Survival Rate ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Complete Resection ◽  
Colorectal Metastases ◽  
Medical Group ◽  
Two Stage ◽  
Second Stage ◽  
Mean Size ◽  
The Impact

Purpose Prolonged survival after two-stage resection (TSR) of advanced colorectal liver metastases (CLM) may be the result of selection of best responders to chemotherapy. The impact of complete resection in this well-selected group is controversial. Patients and Methods Data on 890 patients undergoing resection and 879 patients who received only chemotherapy for CLM were collected prospectively. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR. Additionally, we evaluated a cohort of nonsurgically treated patients selected to mirror the TSR population: colorectal metastases with liver-only disease, objective response to chemotherapy, and alive 1 year after chemotherapy initiation. Results Sixty-five patients underwent the first stage of TSR; 62 patients fulfilled the inclusion criteria for the medical group. TSR patients had a mean of 6.7 ± 3.4 CLM with mean size of 4.5 ± 3.1 cm. Nonsurgical patients had a mean of 5.9 ± 2.9 CLM with mean size of 5.4 ± 3.4 cm (not significant). Forty-seven TSR patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the TSR group and 15% in the medical group (P = .005). In patients who underwent TSR, noncompletion of TSR and major postoperative complications were independently associated with worse survival. Conclusion TSR is associated with excellent outcome in patients with advanced CLM as a result of both selection by chemotherapy and complete resection of metastatic disease.

scholarly journals Impact of homogeneous pathologic response to preoperative chemotherapy in patients with multiple colorectal liver metastases

2017 ◽  
Vol 23 (45) ◽  
pp. 8027-8034
Author(s):  
Charles Sabbagh ◽  
Denis Chatelain ◽  
Christophe Attencourt ◽  
Jean-Paul Joly ◽  
Bruno Chauffert ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Pathologic Response

Two-stage hepatectomy for colorectal liver metastases: A multi-institutional retrospective review.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 351-351
Author(s):  
Nicholas G Berger ◽  
Bradford Kim ◽  
Sepideh Gholami ◽  
Georgios A Margonis ◽  
Cecilia Ethun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Recurrence Free Survival ◽  
Short Term ◽  
Two Stage ◽  
Liver Remnant ◽  
Free Survival ◽  
Second Stage ◽  
Major Complications

351 Background: A significant number of patients with colorectal liver metastases (CRLM) present with unresectable bilobar disease. Two-stage hepatectomy with portal vein embolization (PVE) have been described as a treatment for CRLM allowing for volume regeneration of a functional liver remnant. No large-scale multi-institutional studies exist. The aim of this project was to describe outcomes following two-stage hepatectomy, including overall survival (OS), recurrence-free survival (RFS), and complications. Methods: Patients completing two-stage hepatectomy for CRLM at five US institutions were identified and retrospectively analyzed (2000-2015). Overall survival and recurrence-free survival following second-stage surgery, short-term mortality, Clavien-Dindo complications, and readmission rates were examined. Results: A total of 209 patients were identified. Mean age was 52 (SD +/-11.4), 59.8% were male, and 87.0% had synchronous disease. A total of 65.1% of patients underwent PVE, and 27.3% underwent hepatic artery infusion pump placement. 88.3% of cases underwent neoadjuvant chemotherapy. Following the first stage, 30-day morbidity was 24.4%, with 4.8% major (Clavien-Dindo grade ≥3) complications, and 30-day readmission was 6.7%. Mean time between first and second stage was 4.1 months (S.D. +/-3.1), and 57.5% received systemic chemotherapy between the two resections. Following the second stage, overall complications were 47.4% with 23.9% major complications, and 30-day readmission was 9.7%. Mortality following second stage was 3.8% at 30 days, and 5.3% at 90-days. Following the second stage, RFS at 1-, 3-, and 5-years was 80%, 46%, and 29% respectively. OS at 1-, 3-, and 5-years was 87%, 64%, and 45% respectively. Conclusions: Two-stage hepatectomy for CRLM provides acceptable recurrence-free and overall survival in the context of advanced bilobar disease. Major complications and readmission following the first stage are rare. Following the second stage, short-term major morbidity, mortality, and readmissions are also acceptable. For well-selected patients, two-stage hepatectomy remains a safe and effective treatment for CRLM, with potential for more widespread adoption.

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