Clinical

Two-stage liver resection improves survival significantly versus chemo alone

Last Updated: 2011-01-27 12:40:01 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Two-stage resection (TSR) of advanced bilateral colorectal liver metastases after chemotherapy is associated with "excellent outcome," according to a report from the University of Texas M.D. Anderson Cancer Center, Houston.

On intent-to-treat analysis, the five-year survival rate in patients who responded to chemotherapy and then underwent TSR was 51%, compared with 15% in a matching cohort treated with chemotherapy only (P = 0.005), according to a January 24th online paper in the Journal of Clinical Oncology.

The five-year disease-free survival rate in the TSR patients, treated between 2002 and 2010 and all less than 70 years of age, was 20%.

Altogether, 65 patients underwent the first stage of the surgery. Only 47 completed the second stage, with disease progression the main reason for not having the second operation.

TSR's survival benefit only accrues, however, if both stages of the surgery are performed. The authors found "no benefit of attempted TSR if the strategy could not be completed."

The retrospective study addressed a controversy as to whether the survival benefit of TSR results from complete resection of metastatic disease, or instead from selecting for the surgery only those patients who responded best to chemotherapy.

The authors concluded that the survival benefit associated with this complex surgery comes from three factors: "(1) selection of patients with favorable tumor biology by preoperative chemotherapy, (2) selection of patients with adequate liver hypertrophy and good performance status, and (3) complete resection of metastatic disease."

Better patient selection might further improve the survival rate in patients who complete TSR, the researchers wrote.

Patients with multiple bilateral liver metastases with relative sparing of a portion of the left liver may be candidates for TSR "in the context of stable disease or response to chemotherapy," Dr. Jean-Nicolas Vauthey of M.D. Anderson Cancer Center told Reuters Health by e-mail.

The series of 47 patients who completed both stages of TSR is reportedly the largest such series involving patients with advanced bilateral colorectal liver metastases.

SOURCE: http://bit.ly/ghf88C

J Clin Oncol 2011.