Two-Stage Hepatectomy for Bilobar Colorectal Liver Metastases: Outcomes According to Liver Transplant Selection Criteria.

BACKGROUND

Bilobar colorectal liver metastases (CRLMs) are often addressed through a two-stage hepatectomy (TSH) strategy. The outcomes of TSH according to the presence of criteria used for Liver Transplantation (LT) for unresectable CRLMs has yet to be investigated.

METHODS

We conducted a retrospective review of 100 consecutive patients treated with a TSH. Patients were categorized based on the presence of ideal LT criteria, and compared. The selection criteria included: (1) absence of extrahepatic disease, (2) no metastatic lymph nodes in the hepatic pedicle, (3) tumor diameter less than 55 mm, (4) no disease progression before or between the two surgical stages, and (5) preoperative serum carcinoembryonic antigen (CEA) levels below 80 μg/L.

RESULTS

Based on the selection criteria, 30 patients filled LT criteria, while 70 patients fell outside these criteria. The median overall survival and the survival rates at 1, 3, and 5 years were significantly higher for patients within the LT criteria, with median overall survival of 57 months, and survival rates of 93%, 71%, and 49%, respectively, compared to 27.2 months, 79%, 41%, and 19% for those outside the criteria (p < 0.001). Characteristics of patients in the two groups were largely similar, except that the transplant-criteria group was younger and had a lower Fong's score.

CONCLUSIONS

Patients undergoing TSH for bilobar CRLMs, ideally selected based on strict LT criteria, experienced very favorable long-term survival outcomes. The potential role of LT for bilobar CRLMs addressed through a TSH strategy warrant further investigation in a randomized study.