Back to Search
Start Over
Dangerous halo after neoadjuvant chemotherapy and two-step hepatectomy for colorectal liver metastases
- Source :
- British Journal of Surgery, Vol. 96, No 1 (2009) pp. 95-103
- Publication Year :
- 2008
-
Abstract
- Background Bilobar colorectal metastases are a therapeutic challenge and require a multidisciplinary approach. The aim of this study was to describe the clinical and histological outcomes of patients having neoadjuvant chemotherapy and two-step hepatectomy with right portal vein occlusion for advanced bilateral colorectal metastases. Methods A series of 23 consecutive patients treated with curative intent according to a standardized multidisciplinary management protocol was reviewed. Results Of 23 patients, 22 completed the programme. There was no mortality and no Clavien grade III morbidity. Median survival from the start of treatment was 45 months, and 1-, 3- and 5-year Kaplan–Meier estimates were 95, 73 and 27 per cent respectively. On histology at the first operation, ten patients had a dangerous halo of proliferating tumour cells infiltrating the surrounding liver parenchyma, of variable importance (six focal and four diffuse), regardless of the response to chemotherapy of the metastases. The dangerous halo increased in prevalence and importance (six focal and seven diffuse) between the first and second operation. Conclusion Neoadjuvant chemotherapy followed by two-step hepatectomy with right portal vein occlusion is feasible, safe and may be advantageous to the patient. The appearance of a dangerous halo around the liver metastases may require adaptation of the surgical technique to decrease the risk of local recurrence.
- Subjects :
- Adult
Male
Reoperation
medicine.medical_specialty
medicine.medical_treatment
ddc:616.07
Hepatectomy/*methods/mortality
Chemotherapy, Adjuvant/adverse effects
Occlusion
Antineoplastic Combined Chemotherapy Protocols
medicine
Hepatectomy
Humans
Embolization
Colorectal Neoplasms
Antineoplastic Combined Chemotherapy Protocols/*adverse effects
Survival analysis
Aged
ddc:616
Postoperative Care
Chemotherapy
Reoperation/mortality
ddc:617
business.industry
Postoperative Care/mortality
Portal Vein
Liver Neoplasms
Liver Neoplasms/pathology/secondary/*therapy
Middle Aged
Chemotherapy regimen
Embolization, Therapeutic
Survival Analysis
Surgery
Treatment Outcome
Neoplasm Recurrence, Local/mortality/pathology
Chemotherapy, Adjuvant
Feasibility Studies
Female
Halo
Neoplasm Recurrence, Local
business
Liver parenchyma
Embolization, Therapeutic/methods/mortality
Subjects
Details
- ISSN :
- 13652168 and 00071323
- Volume :
- 96
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The British journal of surgery
- Accession number :
- edsair.doi.dedup.....cde7475d4f4776a14f4d48ba20a149ab