Langenbecks Arch Surg (2014) 399:481–491 DOI 10.1007/s00423-014-1177-7
ORIGINAL ARTICLE
Comparison of various surgical approaches for extensive bilateral colorectal liver metastases Christoph Reissfelder & Nuh N. Rahbari & L. Urrutia Bejarano & Thomas Schmidt & Nikolas Kortes & Hans-Ulrich Kauczor & Markus W. Büchler & Jürgen Weitz & Moritz Koch Received: 25 October 2013 / Accepted: 18 February 2014 / Published online: 11 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Tailored operative strategies have been proposed for patients with bilobar colorectal liver metastases (CLM). The aim of the study was to evaluate the long-term outcome, safety and efficacy, including cancer-specific survival, morbidity, and mortality, of three different surgical strategies for extensive bilateral CLM. Methods This is a retrospective study of a prospective database of 356 consecutive patients, who underwent hepatic resection due to CLM between January 2003 and January 2009. Fifty-nine patients underwent three different therapeutic approaches: 22 patients with portal vein embolization (PVE) + staged resections, 11 patients with staged resections solely, and 26 patients with an extensive liver resection and simultaneous or subsequent radiofrequency ablation (RFA). Results The three groups were comparable regarding their general patient characteristics. The overall morbidity and mortality rates were 27.1 and 1.7 %, respectively. There were no significant differences in morbidity, mortality, or survival between the three groups. The median survival of all patients was 48 months, with a recurrence-free survival of 30 months. C. Reissfelder : N. N. Rahbari : L. U. Bejarano : T. Schmidt : M. W. Büchler : J. Weitz : M. Koch Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany N. Kortes : H.5 cm Preoperative chemotherapy Yes No Recurrence Tumor-related death Recurrence-free survival (months) Liver-specific disease-free survival (months)
0.28
6 (54.5) 5 (45.5)
10 (54.5) 12 (45.5)
16 (61.6) 10 (38.4)
0.48
9 (81.8) 2 (18.2) 11 (100) 2 (18.2) 28 (18.2–37.7) 26 (16.6–36.1)
14 (63.6) 8 (36.4) 17 (77.3) 9 (40.9) 28 (22.6–33.3) 27 (21.2–33.3)
18 (69.2) 8 (30.8) 26 (100) 13 (50) 36 (20.7–51.2) 36 (20.7–51.2)
0.56 0.05 0.46 0.06 0.057
Overall survival (months)
59 (13.2–104.7)
36 (27–44.9)
49 (37.4–60.5)
0.58
p
ORIGINAL ARTICLE
Comparison of various surgical approaches for extensive bilateral colorectal liver metastases Christoph Reissfelder & Nuh N. Rahbari & L. Urrutia Bejarano & Thomas Schmidt & Nikolas Kortes & Hans-Ulrich Kauczor & Markus W. Büchler & Jürgen Weitz & Moritz Koch Received: 25 October 2013 / Accepted: 18 February 2014 / Published online: 11 March 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Tailored operative strategies have been proposed for patients with bilobar colorectal liver metastases (CLM). The aim of the study was to evaluate the long-term outcome, safety and efficacy, including cancer-specific survival, morbidity, and mortality, of three different surgical strategies for extensive bilateral CLM. Methods This is a retrospective study of a prospective database of 356 consecutive patients, who underwent hepatic resection due to CLM between January 2003 and January 2009. Fifty-nine patients underwent three different therapeutic approaches: 22 patients with portal vein embolization (PVE) + staged resections, 11 patients with staged resections solely, and 26 patients with an extensive liver resection and simultaneous or subsequent radiofrequency ablation (RFA). Results The three groups were comparable regarding their general patient characteristics. The overall morbidity and mortality rates were 27.1 and 1.7 %, respectively. There were no significant differences in morbidity, mortality, or survival between the three groups. The median survival of all patients was 48 months, with a recurrence-free survival of 30 months. C. Reissfelder : N. N. Rahbari : L. U. Bejarano : T. Schmidt : M. W. Büchler : J. Weitz : M. Koch Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany N. Kortes : H.5 cm Preoperative chemotherapy Yes No Recurrence Tumor-related death Recurrence-free survival (months) Liver-specific disease-free survival (months)
0.28
6 (54.5) 5 (45.5)
10 (54.5) 12 (45.5)
16 (61.6) 10 (38.4)
0.48
9 (81.8) 2 (18.2) 11 (100) 2 (18.2) 28 (18.2–37.7) 26 (16.6–36.1)
14 (63.6) 8 (36.4) 17 (77.3) 9 (40.9) 28 (22.6–33.3) 27 (21.2–33.3)
18 (69.2) 8 (30.8) 26 (100) 13 (50) 36 (20.7–51.2) 36 (20.7–51.2)
0.56 0.05 0.46 0.06 0.057
Overall survival (months)
59 (13.2–104.7)
36 (27–44.9)
49 (37.4–60.5)
0.58
p
![[Surgical management of disappearing colorectal liver metastases].](/assets/img/hold.png)
