TANI Kimitaka
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Article types Original article
Language English
Peer review Non peer reviewed
Title Evaluation of two-stage hepatectomy using portal vein embolization for colorectal liver metastasis: a retrospective nationwide cohort survey in Japan
Journal Formal name：International journal of surgery
Abbreviation：Int J Surg
ISSN code：17439159/17439159
Domestic / ForeginForegin
Volume, Issue, Page 110(10),pp.6691-6701
Author and coauthor SHIMIZU Takayuki, AOKI Taku, ISHIZUKA Mitsuru, SAKAMOTO Katsunori, BEPPU Toru, HONDA Goro, KOTAKE Kenjiro, YAMAMOTO Masakazu, TAKAHASHI Keiichi, ENDO Itaru, HASEGAWA Kiyoshi, ITABASHI Michio, HASHIGUCHI Yojiro, KOTERA Yoshihito, KOBAYASHI Shin, YAMAGUCHI Tatsuro, NATSUME Soichiro, TABUCHI Ken, KOBAYASHI Hirotoshi, YAMAGUCHI Kensei, TANI Kimitaka, MORITA Satoshi, MIYAZAKI Masaru, SUGIHARA Kenichi, AJIOKA Yoichi
Publication date 2024/10
Summary INTRODUCTION:Two-stage hepatectomy (TSH) enables patients to undergo surgery for colorectal liver metastasis (CRLM), which one-stage hepatectomy cannot remove. Although the outcome of TSH has been reported, there is no original report from Japan. The aim of this retrospective study was to evaluate the outcome of TSH in Japanese patients with CRLM.METHODS:The authors conducted a retrospective cohort study using the nationwide database that included clinical information of 12 519 patients treated with CRLM between 2005 and 2017 in Japan. The primary outcome measure was overall survival. The second outcome measure was progression-free survival. Fisher's exact test, χ 2 test and Mann-Whitney U test were conducted to examine an intergroup difference. Univariate and multivariate analyses were performed using Cox regression model. Survival analysis was performed by Kaplan-Meier method and log-rank test.RESULTS:Of the database, 53 patients undergoing TSH using portal vein embolization (PVE) were identified and analyzed. Their morbidity and in-hospital mortality rates at the second hepatectomy were 26.4% and 0.0%. The mean observation period was 21.8 months. The estimated 1-, 3- and 5-year overall survival rate were 92.5%, 70.8% and 34.7%. Multivariate analyses showed that more than 10 liver nodules significantly increased the mortality risk by 4.2-fold (95% CI 1.224-14.99, P = 0.023). Survival analysis revealed that repeat hepatectomy for disease progression after TSH was superior to chemotherapy in overall survival (mean: 49.6 vs. 18.7, months, P = 0.004).CONCLUSION:In the Japanese cohort, TSH was confirmed to be a safety procedure with an acceptable survival outcome. More than 10 liver nodules may be a predictor for unfavorable outcomes of patients with CRLM undergoing TSH. Furthermore, repeat hepatectomy can be a salvage treatment for resectable intrahepatic recurrence after TSH.
DOI 10.1097/JS9.0000000000001811
PMID 38869986