Advertisement

Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival

Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival

Tumori 2017; 103(2): 170 - 176

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000589

Authors

Guido Griseri, Michela Ceriotti, Andrea Percivale, Angelo Franceschi, Gregorio Santori, Marco Benasso, Riccardo Pellicci

Abstract

Introduction

Surgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals.

Methods

Of 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14.6%) were scheduled for TSH. Thirty-eight/43 received neoadjuvant and/or bridge chemotherapy (2 neoadjuvant only, 4 neoadjuvant and bridge, 32 bridge only).

Results

The mean follow-up was 35.74 ± 29.53 months. Five-year overall survival (OS) was 31.4%, with a median survival time of 31 months. Twenty-nine patients completed the planned procedure (OS: 42.9%; median 47 months), while 14 did not because of disease progression (OS: 0%; median 13 months). No operative mortality occurred within the first 90 days either after the first or second stage.

Conclusions

Our results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome.

Article History

Disclosures

Financial support: None.
Conflict of interest: The authors declare no conflict of interest.

This article is available as full text PDF.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.

Authors

Affiliations

  • General Surgery Unit, San Paolo Hospital, Savona - Italy
  • Postgraduate School of General Surgery, University of Genoa, Genoa - Italy
  • General Surgery Unit, Santa Corona Hospital, Pietra Ligure (Savona)- Italy
  • Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa - Italy
  • Medical Oncology Division, San Paolo Hospital, Savona - Italy

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.