Neoadjuvant Chemotherapy Followed by Two-Step Hepatectomy for Bilateral Hepatic Colorectal Liver Metastases. Clinical and Histological Outcomes with a Focus on the Dangerous Halo
G Mentha, S Terraz, P Morel, A Andres, E Giostra, A Roth, L Rubbia-Brandt, P Majno. University Hospitals of Geneva, Geneva, Switzerland
Background: Bilobar hepatic colorectal metastases (HCRM) require a multidisciplinary approach. Our study describes the clinical and histological outcomes of patients undergoing neo-adjuvant chemotherapy and two-step hepatectomy for bilateral HCRM.
Design: A series of 23 patients was reviewed. HCRM were studied using the standardised Tumour Response Grade (TRG) classification. In addition, we defined a dangerous halo the clustering of cancer cells infiltrating the liver tissue for several millimetres at the periphery of a metastasis, regardless of any signs of response in HCRM and quantified as absent, focal (less than 50% of circumference the metastasis) and diffuse (more than 50% of the circumference of the metastasis). Sinusoidal obstruction syndrome (SOS) and NRH in the non-tumoral liver, frequently associated with oxaliplatin, were graded.
Results: There was no mortality or grade III morbidity. Median survival was 45 months, and 1-5 years Kaplan Meier estimates were 95%, 90%, 73%, 48% and 27%. On histology at the first operation there was a dangerous halo in 46% of the patients, of variable importance, regardless of the response to chemotherapy of HCRM. The dangerous halo increased in prevalence (59%) and importance between the first and the second operation. SOS or NRH appeared at least as severe at the second procedure, and not affected by the longer interval from the last cycle of chemotherapy.
Conclusions: Neoadjuvant chemotherapy followed by two-step hepatectomy is feasible and may be advantageous to the patient. The appearance of a dangerous halo around the liver metastases requires adapting of the surgical technique to decrease the risk of local recurrence.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 178, Tuesday Morning