Timing of two-stage liver resection during chemotherapy for otherwise unresectable colorectal metastases

World Journal of Surgery, 04/11/2012

Optimal timing of hepatectomy and chemotherapy is difficult to specify, but performing the initial resection in a two–stage hepatectomy before chemotherapy may increase likelihood of macroscopic complete resection, even in patients with a poor response to chemotherapy or with limited courses of chemotherapy.


  • Authors retrospectively analyzed the effect of timing of two–stage hepatectomy and chemotherapy using data from 95 patients whose colorectal liver metastases initially were considered unresectable.


  • In 21 of 22 (95 %) patients whose first liver resection preceded chemotherapy (Hx–CTx group) and in 39 of 73 (53 %) patients whose chemotherapy preceded surgery (CTx–Hx group), macroscopic complete resection ultimately was achieved (P < 0.01).
  • Overall and disease–free survivals were comparable between groups.
  • However, overall survival of patients not achieving complete resection in the CTx–Hx group was significantly poorer than that for patients achieving complete resection (P < 0.01).
  • When the 21 patients with complete resection in the Hx–CTx group were compared to the 39 patients with complete resection in the CTx–Hx group, no difference in overall or disease–free survival was observed (P = 0.12 and P = 0.24, respectively), although poor response to chemotherapy was more frequent in the Hx–CTx group.

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