Long-Term Outcomes of Patients Undergoing Two-Stage Hepatectomy For Extensive Colorectal Liver Metastasis Treated With Perioperative Hepatic Artery and Systemic Chemotherapy

Objective: This study analyzed outcomes and clinical differences between patients who completed or failed TSH (cTSH or fTSH), and evaluated predictive factors for cTSH. Background: Two-stage hepatectomy (TSH) is a well-recognized treatment for extensive colorectal liver metastases (CRLM). Methods: A retrospective review of a prospective database identified patients who underwent TSH for extensive CRLM not amenable to a single resection. Patients who submitted to hepatectomy for recurrent CRLM and/or were treated with ablative techniques only, were excluded. Results: Out of 183 (7%) CRLM patients who underwent an initial hepatectomy for TSH, 127 (69%) completed the treatment (cTSH). Median overall survival (OS) after the first hepatectomy was 45 months for the entire cohort, 20.6 months for fTSH, and 65.3 months for cTSH patients. fTSH was due to disease progression. The vast majority of cTSH patients received systemic chemotherapy between stages, including hepatic arterial infusion chemotherapy (HAIC). Compared with cTSH, fTSH patients had more frequent extrahepatic disease (EHD), larger CRLM, more frequent metachronous metastases, and lower pathologic response at first resection. CRLM >5 cm, EHD prior or at the time of the first hepatectomy, and a tumor response ≥70% to neoadjuvant chemotherapy were independently associated with a cTSH. Conclusion: TSH with perioperative systemic chemotherapy and HAIC in patients with extensive CRLM is associated with excellent oncologic outcomes in patients who complete the resection. EHD, larger tumor size, and lower pathologic response rate were associated with fTSH.