| International Session (Symposium) 7 (JSGS・JSGE・JSH) |
| Sat. November 3rd 14:00 - 17:00 Room 4: Portopia Hotel South Wing Portopia Hall |
| Treatment for multiple bilobar colorectal liver metastases: two-stage hepatectomy and concomitant radiofrequency ablation as tools for increasing the resectability | |||
| Katsunori Imai1, Yo-ichi Yamashita1, Hideo Baba1 | |||
| 1Department of Gastroenterological Surgery, Kumamoto University | |||
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| 【Background】To increase the resectability for multiple colorectal liver metastases (CRLM), specific techniques (ST) such as two-stage hepatectomy (TSH) and radiofrequency ablation (RFA) assume a critical role, as with preoperative chemotherapy. 【Methods】From a total cohort of 200 patients who underwent initial hepatectomy for CRLM between 2000 and 2017, 75 patients with multiple bilobar CRLM underwent curative hepatectomy and were enrolled. Among them, 32 patients received ST such as TSH and/or hepatectomy in combination with RFA (Hx+RFA). Short- and long-term outcomes of patients with ST were compared with those without ST. 【Treatment strategy】For multiple bilobar CRLM, we firstly consider one-stage hepatectomy to resect all resectable lesions with tumor-free margins. If removal of all tumors could not be achieved by single hepatectomy, ST were added. RFA was added in case that the tumors were unresectable or deeply located in the remnant liver that acquired extensive resection. If complete treatment was impossible by one-stage hepatectomy, TSH was considered. 【Results】ST included 8 TSH and 28 Hx+RFA. The ST group was characterized primarily as larger tumor number (10.5 vs 4.2, p<0.0001) and initially unresectable disease (71.9 vs 34.9%, p=0.0013). Major complication (Clavien ≥3b) and mortality rates were comparable (9.4 vs 2.3%, p=0.18 and 3.1 vs 0%, p=0.19). There were no differences regarding overall survival (OS) and disease-free survival (DFS) between the two groups (5-year OS: 35.7 vs 54.8%, p=0.30, 5-year DFS: 11.4 vs 13.2%, p=0.77). 【Conclusions】ST could increase the resectability without compromising the short- and long-term outcomes in the setting of multiple bilobar CRLM. |
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Index Term 1: colorectal liver metastases Index Term 2: specific technique |
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