Two-Stage Hepatectomy Is Potentially Curative for Patients With Irresectable Liver Metastases From Colorectal Cancer: Presented at ASCO-GI
ORLANDO, FL -- January 29, 2008 -- Two-stage hepatectomy can be considered an established and potentially curative strategy for treatment of selected patients with irresectable multiple bilobar colorectal cancer (CRC) liver metastases, a French researcher reported.
RenÚ Adam, MD, Hospital Surgeon, President, Consultative Medical Committee, Centre Hepato-Biliaire, H˘pital Paul Brousse, Villejuif, France, presented the results of his large single-center experience at an oral session here on January 27 at the American Society for Clinical Oncology's 2008 Gastrointestinal Cancers Symposium (ASCO-GI).
The symposium is cosponsored by ASCO with the American Gastroenterological Association Institute, the American Society for Therapeutic Radiology and Oncology, and the Society for Surgical Oncology.
Dr. Adam said that two-stage hepatectomy is a planned strategy, "based on the concept of regeneration."
Between October 1992 and October 2006, Dr. Adam said he referred 51 patients with CRC liver metastases for two-stage hepatectomy, as "it was impossible to resect the whole tumor in one operation."
He said the strategy has evolved over time, with 2% of patients referred for treatment from 1992 to 1994 versus 14% from 2004 to 2006.
The surgery was feasible in 69% of 51 patients, with the major reason for nonfeasibility being disease progression or poor performance status, he said.
Patients had a mean of 9.6 metastases with a mean maximum diameter of 50.2 mm at diagnosis. Eighty percent had synchronous metastases. Concomitant extrahepatic disease was present in 17% of patients.
All but one patient (97%) received preoperative chemotherapy, 77% continued chemotherapy between the two procedures, and 74% also received adjunct chemotherapy after the second procedure. The mean delay between the two liver resections was 4.3 months.
The 5-year mortality rate for patients on an intent-to-treat basis (51 patients) was 30%.
For the 35 patients who completed both hepatectomies, the overall 3- and 5-year survival rates were 57% and 39%, respectively, from the time of the first surgery. Disease-free survival rates were 24% and 12% at 3 and 5 years, respectively.
Of the 16 patients who failed, all but two died, with a median time to death of about 1 year, Dr. Adam said.
"With this technique it is possible that 20% more patients in the group initially considered to be nonresectable can be switched to resectability," Dr. Adam said in an interview.