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 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

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.

scholarly journals Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases

2018 ◽  
Vol 6 (6) ◽  
pp. 1046-1051
Author(s):  
Stefan Petrovski ◽  
Marija Karakolevska-Ilova ◽  
Elena Simeonovska-Joveva ◽  
Aleksandar Serafimov ◽  
Ljubica Adzi-Andov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Poor Prognosis ◽  
Colorectal Liver Metastases ◽  
Patient Survival ◽  
Radical Resection ◽  
Colorectal Metastases ◽  
Specific Technique ◽  
Left Hemihepatectomy ◽  
The Impact

INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.

Prolonged survival after two-stage resection of advanced colorectal liver metastases: Impact of an intensified chemotherapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 748-748
Author(s):  
Marie-Hélène Pissas ◽  
Sebastien Carrere ◽  
Lise Roca ◽  
Pierre-Emmanuel Colombo ◽  
Martin Bertrand ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Median Overall Survival ◽  
Two Stage ◽  
Excellent Outcome ◽  
Second Resection ◽  
Intensified Chemotherapy ◽  
Two Stages ◽  
The Impact

748 Background: Patients with advanced colorectal liver metastases (CRLM) experience poor prognosis. The impact of two-stage resection (TSR) after downstaging by chemotherapy is still controversial. Methods: Data on 899 patients with CRLM in a single institution during a 9-year period (2004–2013) were prospectively collected. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR associated with intensified chemotherapy before and between the two surgical stages. Results: 73 patients were eligible for the first stage of TSR. In this population, 54 patients underwent an intensified chemotherapy based on FOLFIRINOX (26 patients) or a standard chemotherapy associated with cetuximab or bevacizumab (28 patients). The first surgical stage was a clearance of the left liver in 56% of cases. An average of two radio-frequency ablations and two wedge resections were necessary. The post-operative morbidity of the first stage was 18%. 78% of patients received chemotherapy between the two stages. The average interval between two stages was 228 days (36-1561). 68% of TSR patients completed the second stage. The second resection was mainly a standard right lobectomy (32%). Morbidity after the second resection was 12%. One patient died post-operatively because of post operative liver failure. Median overall survival of patients who completed TSR was 48 months. In contrast, there was no survival advantage for patients who underwent only the first stage because of progression (median overall survival: 19 months) (p = 0.0003). The median overall survival of the whole population was 43 months and the median recurrence-free survival was 15 months. Conclusions: Intensified chemotherapy in association with TSR allows excellent outcome in patients with advanced CRLM. Chemotherapy delivered between the two surgical stages is responsible for an important waiting time but could contribute to a better control of the evolution of the disease.

scholarly journals Failure to Cure Colorectal Liver Metastases Patients Quantified - The Impact of the Liver Surgical Specialist

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S129
Author(s):  
E.A. Vega ◽  
O. Salehi ◽  
O. Kocyreva ◽  
C. Conrad
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
The Impact

scholarly journals Repeat hepatectomy for recurrent colorectal liver metastases is associated with a high survival rate

HPB ◽  
2011 ◽  
Vol 13 (11) ◽  
pp. 774-782 ◽  
Author(s):  
Andreas Andreou ◽  
Antoine Brouquet ◽  
Eddie K. Abdalla ◽  
Thomas A. Aloia ◽  
Steven A. Curley ◽  
...  
Keyword(s):  
Survival Rate ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Repeat Hepatectomy ◽  
High Survival ◽  
High Survival Rate

Benchmarking the efficiencies of Indonesia’s municipal water utilities using Stackelberg data envelopment analysis

2015 ◽  
Vol 22 (4) ◽  
pp. 588-609 ◽  
Author(s):  
Andreas Wibowo ◽  
Hans Wilhelm Alfen
Keyword(s):  
Data Envelopment Analysis ◽  
The Body ◽  
Water Utilities ◽  
Data Envelopment ◽  
Two Stage ◽  
Restrictive Assumption ◽  
Content Type ◽  
Second Stage ◽  
Municipal Water ◽  
The Impact

Purpose – The purpose of this paper is to present a yardstick efficiency comparison of 269 Indonesian municipal water utilities (MWUs) and measures the impact of exogenous environmental variables on efficiency scores. Design/methodology/approach – Two-stage Stackelberg leader-follower data envelopment analysis (DEA) and artificial neural networks (ANN) were employed. Findings – Given that serviceability was treated as the leader and profitability as the follower, the first and second stage DEA scores were 55 and 32 percent (0 percent = totally inefficient, 100 percent = perfectly efficient), respectively. This indicates sizeable opportunities for improvement, with 39 percent of the total sample facing serious problems in both first- and second-stage efficiencies. When profitability instead leads serviceability, this results in more decreased efficiency. The size of the population served was the most important exogenous environmental variable affecting DEA efficiency scores in both the first and second stages. Research limitations/implications – The present study was limited by the overly restrictive assumption that all MWUs operate at a constant-return-to-scale. Practical implications – These research findings will enable better management of the MWUs in question, allowing their current level of performance to be objectively compared with that of their peers, both in terms of scale and area of operation. These findings will also help the government prioritize assistance measures for MWUs that are suffering from acute performance gaps, and to devise a strategic national plan to revitalize Indonesia’s water sector. Originality/value – This paper enriches the body of knowledge by filling in knowledge gaps relating to benchmarking in Indonesia’s water industry, as well as in the application of ensemble two-stage DEA and ANN, which are still rare in the literature.

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