Failure to Achieve a 2-Stage Hepatectomy for Colorectal Liver Metastases: How to Prevent It?
Ann Surg
; 262(5): 772-8; discussion 778-9, 2015 Nov.
Article
en En
| MEDLINE
| ID: mdl-26583665
ABSTRACT
OBJECTIVES:
The aim of the study was to identify predictive factors of failure of 2-stage hepatectomy (TSH) for the selection of patients with extensive bilobar colorectal liver metastases (CRLM), who are candidates for TSH.BACKGROUND:
The main weakness of TSH is the risk of failure to complete both the sequential procedures.METHODS:
Between 2000 and 2012, from a total cohort of 845 patients resected for CRLM, 125 patients (14.8%) with extensive CRLM were planned for TSH. All factors related to the failure of TSH were analyzed, and a predictive model was built utilizing the independent predictive factors of failure.RESULTS:
Forty-four patients (35.2%) could not proceed to the second stage, and their overall survival (OS) was significantly worse than that of those who completed the TSH (5-year OS 0% vs 44.2%; Pâ<â0.0001). Multivariate analysis revealed that carcinoembryonic antigen >30âng/mL [relative risk (RR) 2.73, Pâ=â0.03], tumor size >40âmm (RR 2.89, Pâ=â0.04), chemotherapy cycles >12 (RR 3.46, Pâ=â0.01), and tumor progression during first-line chemotherapy (RR 6.56, Pâ=â0.01) were independent predictive factors of failure. For patients not presenting any factors, the probability of failure was 10.5%, with a 5-year OS rate of 41.9%. The addition of each subsequent factor increased the risk to 43.5%, 72.7%, 88.5%, and 95.5%, and decreased the 5-year OS to 38.8%, 29.2%, 0%, and 0%, respectively, for 1, 2, 3, and 4 factors.CONCLUSIONS:
TSH should not be recommended in patients with more than 2 risk factors. Avoidance of these factors significantly reduces the risk of failure and is crucial for long-term survival.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Colorrectales
/
Hepatectomía
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Neoplasias Hepáticas
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Ann Surg
Año:
2015
Tipo del documento:
Article
País de afiliación:
Francia