The Two-stage hepatectomy in resection of colorectal liver metastases — A single-institution experience with case‒control matching and review of the literature

Abstract

Background. This study aimed to determine the outcomes of two-stage hepatectomy (TSH) for extensive bilateral colorectal liver metastases (CLMs).

Patients and methods. A retrospective review of a prospectively maintained database of 632 consecutive liver resections between 2000 and 2020 was conducted. The study group (TSH) consisted of 15 patients who had completed TSH. The control group included 151 patients who underwent one-stage hepatectomy (OSH). Case‒control matching (CCM) was performed.

Results. The rate of completion of two-stage procedures was 74%. The median overall survival in the TSH group was 21 months, and the 3- and 5-year survival rates were 33% and 13%, respectively. Recurrence-free survival (RFS) in the TSH group was five months. After case‒control matching, the median overall survival in the CCM-OSH group was 23 months (P=0.575). The 3- and 5-year survival rates were 36% and 21%, respectively. RFS was eight months.

Conclusions. TSH used to be a safe and favourable therapeutic choice in a selected population of patients because it could prevent PHLF and enables good oncological results. OSH should be preferred whenever feasible because it has lower morbidity and equivalent oncological outcomes as completed TSH.