Amroun KL1*, Piardi T1, Chetboun M1, Sommacale D1, Kianmanesh R1, Djerada Z2 and Bouché O3
1Department of Digestive and Endocrine Surgery, Robert Debré University hospital, France
2Department of Pharmacology, Maison-Blanche University Hospital, France
3Department of Hepatogastroenterology and Medical Oncology, Robert Debré University Hospital, France
Introduction: Complex therapeutic strategies were developed to allow surgical resection of initially unresectable or hardly resectable colorectal liver metastases. That consists on downsizing chemotherapy, one- or two-stage hepatectomy. However, some patients could not complete all therapeutic steps. The aim of this study is to assess associated factors of failure and occurrence of postoperative complications.Methods: Univariate and multivariate analysis were performed to highlight associated factors that may compromise the success of the therapeutic strategy. Actuarial survival was assessed comparing patients who completed all therapeutic strategy to those who failed and those treated by palliative chemotherapy.Results: Among 63 patients with initially hardly resectable or unresectable LM, 45 were selected to intend surgical resection. Non-response to down-sizing chemotherapy was associated to a body mass index (BMI) ≥25 kg/m² (OR=0.073). In two-stage hepatectomy, size of LM ≥5 cm (OR = 0.093) was the associated factors of failure to reach the second step surgery. Especially when pooled with a number of LM ≥5 (0.012). Occurrence of postoperative morbidity was associated to the necessity of perioperative transfusion (OR=12). Postoperative mortality was associated to the need of perioperative transfusion (OR=23.25). Especially when pooled to size of LM ≥5 cm (OR=5.47). Three-year overall survival rate was 64.9% when patients completed therapeutic strategy.Conclusion: despite the limits of our study, we identified associated factors of poor response to chemotherapy, of failure of two-step surgery and occurrence of postoperative complications.
Amroun KL, Piardi T, Chetboun M, Sommacale D, Kianmanesh R, Djerada Z, et al. Unresectable Liver Metastases from Colorectal Cancer: Any Limits for Radical Hepatectomy? Clin Surg. 2016; 1: 1141.