Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

Turk, Spela; Plahuta, Irena; Magdalenic, Tomislav; Spanring, Tajda; Laufer, Kevin; Mavc, Zan; Potrc, Stojan; Ivanecz, Arpad

Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

Radiology and Oncology

Volume 57 (2023): Issue 2 (June 2023)

By:

Spela Turk, Irena Plahuta, Tomislav Magdalenic, Tajda Spanring, Kevin Laufer, Zan Mavc, Stojan Potrc and Arpad Ivanecz

Open Access

|Jun 2023

Figures & Tables

The study flowchart. The study period covers 1 January 2000 to 31 December 2020.ALPPS = associating liver partition and portal vein ligation for staged hepatectomy; CCM-OSH = case-control matching one-stage hepatectomy; CLMs = colorectal liver metastases; OSH = one-stage hepatectomy; PVE = portal vein embolization; PVL = portal vein ligation; RFA = radiofrequency ablation; TSH = two-stage hepatectomy

Overall survival after case-control matching (TSH vs. case-control matching-OSH groups), P = 0.575.CCM-OSH = case-control matching one-stage hepatectomy; TSH = two-stage hepatectomy

Survival analysis

	Overall	OSH (n = 151)	TSH (n = 15)	P value
Median OS (months) [95% CI]	35 [30–40]	35 [31–39]	21 [17–25]	0.063
3-year OS	48%	49%	33%	0.107
5-year OS	26%	27%	13%	0.107
RFS (months) [95% CI]	11 [8–14]	11 [9–13]	5 [2–8]	0.138
3-year RFS	14%	15%	13%	0.070
5-year RFS	10%	10%	7%	0.070
After case-control matching
	Overall	CCM-OSH (N=14)	TSH (N=15)	P value
Median OS (months) [95% CI]	23 [19–27]	23 [5–41]	21 [17.0–25.0]	0.575
3-year OS	34%	36%	33%	0.743
5-year OS	17%	21%	13%	0.743
RFS (months) [95% CI]	7 [4–10]	8 [1–15]	5 [2–8]	0.888
3-year RFS	14%	14%	13%	0.498
5-year RFS	3%	0%	7%	0.498

Clinical characteristics and perioperative outcomes of the 166 patients

Clinical characteristics	OSH (n=151)	TSH (n=15)	P value
Male sex ^a	109 (72.2%)	13 (86.7%)	0.365
Age (years) ^b	62 (34–84; 14)	64 (45–75; 12)	0.819
ASA score ≥ 3 ^a	32 (21.2%)	2 (13.3%)	0.701
Primary tumour location ^c
Right colon	27 (17.9%)	1 (6.7%)	0.166
Left colon	61 (40.4%)	6 (40.0%)
Rectum	61 (40.4%)	7 (46.7%)
> 1 primary tumour	2 (1.3%)	1 (6.7%)
Primary tumour nodal invasion ^a	99 (66.0%)	10 (66.7%)	1.000
Synchronous liver metastases ^a	81 (53.6%)	11 (73.3%)	0.179
Number of liver metastases ^b	3 (1–19; 3)	5 (2–12; 6)	0.001
Size of liver metastases (cm) ^b	4 (0.6–20; 3)	5 (1.5–11; 5.5)	0.183
Neoadjuvant chemotherapy ^a	79 (52.3%)	13 (86.7%)	0.013
Preoperative CEA level (ng/mL) ^b	14 (1–1359; 47.5)	12 (2–1312; 60)	0.464
Extrahepatic disease ^a	27 (17.9%)	3 (20.0%)	1.000
Clinical risk score 3–5 ^a	92 (60.9%)	10 (66.7%)	0.875
Major liver resection ^a	58 (38.4%)	15 (100%)	<0.001
Atypical resection	29 (19.2%)	0 (0.0%)	/
Segmentectomy/segmentectomy & atypical resection	3 (2.0%)/14 (9.3%)	0 (0.0%)	/
Bisegmentectomy/bisegmentectomy & atypical resection	10 (6.6%)/37 (24.5%)	0 (0.0%)	/
Right/extended right hepatectomy	28 (18.5%)/6 (4.0%)	13 (86.7%)/2 (13.3%)	/
Left/extended left hepatectomy	6 (4.0%)/3 (2.0%)	0 (0.0%)	/
Trisegmentectomy	6 (4.0%)	0 (0.0%)	/
Trisegmentectomy & atypical resection	5 (3.3%)	0 (0.0%)	/
Central resection	4 (2.6%)	0 (0.0%)	/
R0 resection ^a	118 (78.1%)	10 (66.7%)	0.492
CD ≥ 3a ^a	31 (20.5%)	6 (40.0%)	0.161
90-day mortality ^a	7 (4.6%)	2 (13.3%)	0.189
ISGLS haemorrhage grade C ^a	2 (1.3%)	0 (0.0%)	1.000
ISGLS bile leakage grade C ^a	5 (3.3%)	1 (6.7%)	1.000
ISGLS liver failure – any grade ^a	40 (26.5%)	12 (80.0%)	<0.001
Grade A ^a	16 (10.6%)	5 (33.3%)	0.034
Grade B ^a	19 (12.6%)	6 (40.0%)	0.014
Grade C ^a	5 (3.3%)	1 (6.7%)	1.000
Hospital stay (days) ^b	10 (5–63; 7)	14 (8–158; 11)	0.028

Clinical characteristics of the matched groups

Clinical characteristics	CCM-OSH (n = 14)	TSH (n = 15)	P value
Male sex ^a	11(78.6%)	13(86.7%)	1.000
Age (years) ^b	60 (53–78; 13)	64 (45–75; 12)	0.463
ASA score ≥ 3 ^a	2 (14.3%)	2 (13.3%)	1.000
Primary tumour in right colon ^a	2 (14.3%)	1 (6.7%)	1.000
Primary tumour in left colon ^a	10 (71.4%)	6 (40%)	0.125
Primary tumour in rectum ^a	2 (14.3%)	7 (46.7%)	0.063
> 1 primary tumour ^a	0 (0.0%)	1 (6.7%)	1.000
Primary tumour nodal invasion ^a	10 (71.4%)	10 (66.7%)	1.000
Synchronous liver metastases ^a	11(78.6%)	11(73.3%)	1.000
Number of liver metastases ^b	5 (2–12; 6)	5 (2–12; 6)	0.317
Size of liver metastases (cm) ^b	4.6 (1–20; 7)	5 (1.5–11; 5.5)	0.463
Neoadjuvant chemotherapy ^a	13 (92.9%)	13 (86.7%)	1.000
Preoperative CEA level (ng/mL) ^b	9 (1–261; 76)	12 (2–1312; 60)	0.975
Extrahepatic disease ^a	1 (7.1%)	3 (20.0%)	1.000
Clinical risk score 3–5 ^a	13 (92.9%)	10 (66.7%)	0.250
Major hepatectomy ^a	14(100%)	15 (100%)	1.000
Right/extended right hepatectomy	8 (57.1%)/2 (14.3%)	13 (86.7%)/2 (13%)	/
Left hemihepatectomy	1 (7.1%)	0 (0.0%)	/
Trisegmentectomy & atypical resection	3 (21.4%)	0 (0.0%)	/
R0 resection ^a	8 (57.1%)	10 (66.7%)	1.000
CD ≥ 3a ^a	4 (28.6%)	6 (40.0%)	0.688
90-day mortality ^a	1 (7.1%)	2 (13.3%)	1.000
ISGLS haemorrhage grade C ^a	0 (0.0%)	0 (0.0%)	1.000
ISGLS bile leakage grade C ^a	1 (7.1%)	1 (6.7%)	1.000
ISGLS liver failure – any grade ^a	10 (71.4%)	12 (80%)	1.000
Grade A ^a	4 (28.6%)	5 (33.3%)	1.000
Grade B ^a	5 (35,7%)	6 (40.0%)	1.000
Grade C ^a	1 (7.1%)	1 (6.7%)	1.000
Hospital stay (days) ^b	16 (6–63; 13)	14 (8–158; 11)	0.406

Literature review of surgical outcomes and survival after two-stage hepatectomy for colorectal liver metastases

Authors	Year	Study period	N of patients	Major liver resection (%)	R0 resection (%)	Morbidity (%)	Mortality (%)	Median follow-up (months)	Median RFS (months)	3-y RFS (%)	5-y RFS (%)	Median OS (months)	3-y OS (%)	5-y OS (%)
Adam et al., France⁴	2000	1992–1999	13	62	NR	45	15	22	NR	31	31	44	35	NR
Tanaka et al., Japan¹⁷	2007	1992–2004	22	67	87	23	0	NR	NR	6	NR	NR	33	NR
Wicherts et al., France²⁴	2008	1992–2007	41	76	NR	59	7	24	NR	26	13	39	60	42
Narita et al., France²⁵	2011	1996–2009	61	95	NR	54	0	30	NR	15	8	40	59	32
Turrini et al., France²⁶	2012	2000–2010	34	91	100	20	6	41	NR	24	14	44	59	35
Omichi et al., Japan²⁷	2022	2013–2019	32	NR	78	22	0	17	6	NR	NR	41	61	NR
The present study, Slovenia	2023	2000–2020	15	100	67	40	13	174	7	13	7	21	33	13
Multicentre studies
Tsai et al., USA and Portugal²⁸	2010	1994–2008	35	80	NR	26	5	NR	NR	NR	NR	16	58	NR
Regimbeau et al. LiverMetSurvey registry⁵	2017	2000–2014	625	NR	58	25	9	84^a	41^a	43	23	40^a	45	23
Petrowsky et al. ALPPS registry²⁹	2020	2009–2019	510	100	73	21	5	38	11	19	12	37	52	27
Chavez et al. Five centres in the USA²²	2021	2000–2016	196	76	92	23	5	28	NR	19	18	50	64	44

DOI: https://doi.org/10.2478/raon-2023-0026 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 270 - 278

Submitted on: Mar 18, 2023

Accepted on: May 15, 2023

Published on: Jun 21, 2023

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 times per year

Keywords:

colorectal cancer,

liver metastases,

hepatectomy,

future liver remnant,

posthepatectomy liver failure,

Related subjects:

Haematology, oncology,

Radiology

© 2023 Spela Turk, Irena Plahuta, Tomislav Magdalenic, Tajda Spanring, Kevin Laufer, Zan Mavc, Stojan Potrc, Arpad Ivanecz, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Previous article Volume 57 (2023): Issue 2 (June 2023)

Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

Figures & Tables

FIGURE 1.

FIGURE 2.

Survival analysis

Clinical characteristics and perioperative outcomes of the 166 patients

Clinical characteristics of the matched groups

Literature review of surgical outcomes and survival after two-stage hepatectomy for colorectal liver metastases

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