Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?
Abstract Background Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chan...
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| Veröffentlicht in: | European journal of surgical oncology 2016-09, Vol.42 (9), p.1385-1393 |
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| creator | Viganò, L., MD PhD Torzilli, G., MD PhD F.A.C.S Cimino, M., MD Imai, K., MD Vibert, E., MD Donadon, M., MD PhD Castaing, D., MD Adam, R., MD PhD |
| description | Abstract Background Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. Methods All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period. Matching criteria were: primary tumor N status; timing of CLM diagnosis; CLM number and distribution into the liver. Results Sixty-three pairs of patients were analyzed. Demographic and tumor characteristics were similar (median 7 CLM), except for more chemotherapy lines and adjuvant chemotherapy in TSH. Drop-out rate of TSH was 38.1% (0% of OSH). The two groups had similar R0 resection rate (19.0% OSH vs. 15.9% TSH). OSH and completed TSH had similar five-year survival (from CLM diagnosis 49.8% vs. 49.7%, from liver resection 36.1% vs. 44.3%), superior to drop-out (10% three-year survival, p |
| doi_str_mv | 10.1016/j.ejso.2016.03.020 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1814645288</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0748798316300348</els_id><sourcerecordid>1814645288</sourcerecordid><originalsourceid>FETCH-LOGICAL-c477t-3767083de46e0447f8d4ee946ff73116081d80fa7f12d8e8a8dfb2ad29fee9bf3</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EotvCH-CAfOSSMP7Y2CshUFXKh1QJJOBseZ0x65CNF9tptf8ehy0cOHCyZT_vaOYZQp4xaBmw7uXQ4pBjy-u9BdEChwdkxdaCN5yt1UOyAiV1ozZanJHznAcA2Ai1eUzOuBKs64CtyO5tiocmzoVusdwhTrTskJa7SMdwi4kmzOhKiFOm0S_vTS72O9IdHmypP3F_bOlnWwJOhWYcTzCNiY4x_864nZ0cvnlCHnk7Znx6f16Qb--uv159aG4-vf94dXnTOKlUaYTqFGjRo-wQpFRe9xJxIzvva8-sA816Dd4qz3ivUVvd-y23Pd_4im29uCAvTnUPKf6cMRezD9nhONoJ45wN00x2cs21rig_oS7VXhN6c0hhb9PRMDCLYTOYxbBZDBsQphquoef39eftHvu_kT9KK_DqBGCd8jZgMtlVOw77kKod08fw__qv_4m7MUzB2fEHHjEPcU5T9WeYydyA-bLseFkx6wSAkFr8Arqfos4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1814645288</pqid></control><display><type>article</type><title>Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Viganò, L., MD PhD ; Torzilli, G., MD PhD F.A.C.S ; Cimino, M., MD ; Imai, K., MD ; Vibert, E., MD ; Donadon, M., MD PhD ; Castaing, D., MD ; Adam, R., MD PhD</creator><creatorcontrib>Viganò, L., MD PhD ; Torzilli, G., MD PhD F.A.C.S ; Cimino, M., MD ; Imai, K., MD ; Vibert, E., MD ; Donadon, M., MD PhD ; Castaing, D., MD ; Adam, R., MD PhD</creatorcontrib><description>Abstract Background Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. Methods All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period. Matching criteria were: primary tumor N status; timing of CLM diagnosis; CLM number and distribution into the liver. Results Sixty-three pairs of patients were analyzed. Demographic and tumor characteristics were similar (median 7 CLM), except for more chemotherapy lines and adjuvant chemotherapy in TSH. Drop-out rate of TSH was 38.1% (0% of OSH). The two groups had similar R0 resection rate (19.0% OSH vs. 15.9% TSH). OSH and completed TSH had similar five-year survival (from CLM diagnosis 49.8% vs. 49.7%, from liver resection 36.1% vs. 44.3%), superior to drop-out (10% three-year survival, p<0.001). OSH and completed TSH had similar recurrence-free survival (at three years 21.7% vs. 20.5%) and recurrence sites. The completion of resection (drop-out vs. OSH/completed TSH) was the only independent prognostic factor (p=0.003). Conclusions Drop-out of TSH could be a loss of chance rather than a criteria for patient selection. “Unselected” OSH patients had the same outcomes of selected patients who completed TSH. A complete resection is the main determinant of prognosis.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2016.03.020</identifier><identifier>PMID: 27316601</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Chemotherapy, Adjuvant - statistics & numerical data ; Colorectal liver metastases ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Disease-Free Survival ; Drop-out ; Female ; France ; Hematology, Oncology and Palliative Medicine ; Hepatectomy ; Humans ; Liver Neoplasms - mortality ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Middle Aged ; One-stage hepatectomy ; Overall survival and recurrence-free survival ; Patient Dropouts - statistics & numerical data ; Patient Selection ; Prognosis ; Retrospective Studies ; Surgery ; Surgical margin ; Two-stage hepatectomy</subject><ispartof>European journal of surgical oncology, 2016-09, Vol.42 (9), p.1385-1393</ispartof><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-3767083de46e0447f8d4ee946ff73116081d80fa7f12d8e8a8dfb2ad29fee9bf3</citedby><cites>FETCH-LOGICAL-c477t-3767083de46e0447f8d4ee946ff73116081d80fa7f12d8e8a8dfb2ad29fee9bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0748798316300348$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27316601$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Viganò, L., MD PhD</creatorcontrib><creatorcontrib>Torzilli, G., MD PhD F.A.C.S</creatorcontrib><creatorcontrib>Cimino, M., MD</creatorcontrib><creatorcontrib>Imai, K., MD</creatorcontrib><creatorcontrib>Vibert, E., MD</creatorcontrib><creatorcontrib>Donadon, M., MD PhD</creatorcontrib><creatorcontrib>Castaing, D., MD</creatorcontrib><creatorcontrib>Adam, R., MD PhD</creatorcontrib><title>Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Abstract Background Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. Methods All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period. Matching criteria were: primary tumor N status; timing of CLM diagnosis; CLM number and distribution into the liver. Results Sixty-three pairs of patients were analyzed. Demographic and tumor characteristics were similar (median 7 CLM), except for more chemotherapy lines and adjuvant chemotherapy in TSH. Drop-out rate of TSH was 38.1% (0% of OSH). The two groups had similar R0 resection rate (19.0% OSH vs. 15.9% TSH). OSH and completed TSH had similar five-year survival (from CLM diagnosis 49.8% vs. 49.7%, from liver resection 36.1% vs. 44.3%), superior to drop-out (10% three-year survival, p<0.001). OSH and completed TSH had similar recurrence-free survival (at three years 21.7% vs. 20.5%) and recurrence sites. The completion of resection (drop-out vs. OSH/completed TSH) was the only independent prognostic factor (p=0.003). Conclusions Drop-out of TSH could be a loss of chance rather than a criteria for patient selection. “Unselected” OSH patients had the same outcomes of selected patients who completed TSH. A complete resection is the main determinant of prognosis.</description><subject>Aged</subject><subject>Chemotherapy, Adjuvant - statistics & numerical data</subject><subject>Colorectal liver metastases</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Disease-Free Survival</subject><subject>Drop-out</subject><subject>Female</subject><subject>France</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Hepatectomy</subject><subject>Humans</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>One-stage hepatectomy</subject><subject>Overall survival and recurrence-free survival</subject><subject>Patient Dropouts - statistics & numerical data</subject><subject>Patient Selection</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical margin</subject><subject>Two-stage hepatectomy</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EotvCH-CAfOSSMP7Y2CshUFXKh1QJJOBseZ0x65CNF9tptf8ehy0cOHCyZT_vaOYZQp4xaBmw7uXQ4pBjy-u9BdEChwdkxdaCN5yt1UOyAiV1ozZanJHznAcA2Ai1eUzOuBKs64CtyO5tiocmzoVusdwhTrTskJa7SMdwi4kmzOhKiFOm0S_vTS72O9IdHmypP3F_bOlnWwJOhWYcTzCNiY4x_864nZ0cvnlCHnk7Znx6f16Qb--uv159aG4-vf94dXnTOKlUaYTqFGjRo-wQpFRe9xJxIzvva8-sA816Dd4qz3ivUVvd-y23Pd_4im29uCAvTnUPKf6cMRezD9nhONoJ45wN00x2cs21rig_oS7VXhN6c0hhb9PRMDCLYTOYxbBZDBsQphquoef39eftHvu_kT9KK_DqBGCd8jZgMtlVOw77kKod08fw__qv_4m7MUzB2fEHHjEPcU5T9WeYydyA-bLseFkx6wSAkFr8Arqfos4</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Viganò, L., MD PhD</creator><creator>Torzilli, G., MD PhD F.A.C.S</creator><creator>Cimino, M., MD</creator><creator>Imai, K., MD</creator><creator>Vibert, E., MD</creator><creator>Donadon, M., MD PhD</creator><creator>Castaing, D., MD</creator><creator>Adam, R., MD PhD</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160901</creationdate><title>Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?</title><author>Viganò, L., MD PhD ; Torzilli, G., MD PhD F.A.C.S ; Cimino, M., MD ; Imai, K., MD ; Vibert, E., MD ; Donadon, M., MD PhD ; Castaing, D., MD ; Adam, R., MD PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-3767083de46e0447f8d4ee946ff73116081d80fa7f12d8e8a8dfb2ad29fee9bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Chemotherapy, Adjuvant - statistics & numerical data</topic><topic>Colorectal liver metastases</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Disease-Free Survival</topic><topic>Drop-out</topic><topic>Female</topic><topic>France</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Hepatectomy</topic><topic>Humans</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>One-stage hepatectomy</topic><topic>Overall survival and recurrence-free survival</topic><topic>Patient Dropouts - statistics & numerical data</topic><topic>Patient Selection</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical margin</topic><topic>Two-stage hepatectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Viganò, L., MD PhD</creatorcontrib><creatorcontrib>Torzilli, G., MD PhD F.A.C.S</creatorcontrib><creatorcontrib>Cimino, M., MD</creatorcontrib><creatorcontrib>Imai, K., MD</creatorcontrib><creatorcontrib>Vibert, E., MD</creatorcontrib><creatorcontrib>Donadon, M., MD PhD</creatorcontrib><creatorcontrib>Castaing, D., MD</creatorcontrib><creatorcontrib>Adam, R., MD PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Viganò, L., MD PhD</au><au>Torzilli, G., MD PhD F.A.C.S</au><au>Cimino, M., MD</au><au>Imai, K., MD</au><au>Vibert, E., MD</au><au>Donadon, M., MD PhD</au><au>Castaing, D., MD</au><au>Adam, R., MD PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance?</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>42</volume><issue>9</issue><spage>1385</spage><epage>1393</epage><pages>1385-1393</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Abstract Background Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. Methods All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period. Matching criteria were: primary tumor N status; timing of CLM diagnosis; CLM number and distribution into the liver. Results Sixty-three pairs of patients were analyzed. Demographic and tumor characteristics were similar (median 7 CLM), except for more chemotherapy lines and adjuvant chemotherapy in TSH. Drop-out rate of TSH was 38.1% (0% of OSH). The two groups had similar R0 resection rate (19.0% OSH vs. 15.9% TSH). OSH and completed TSH had similar five-year survival (from CLM diagnosis 49.8% vs. 49.7%, from liver resection 36.1% vs. 44.3%), superior to drop-out (10% three-year survival, p<0.001). OSH and completed TSH had similar recurrence-free survival (at three years 21.7% vs. 20.5%) and recurrence sites. The completion of resection (drop-out vs. OSH/completed TSH) was the only independent prognostic factor (p=0.003). Conclusions Drop-out of TSH could be a loss of chance rather than a criteria for patient selection. “Unselected” OSH patients had the same outcomes of selected patients who completed TSH. A complete resection is the main determinant of prognosis.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27316601</pmid><doi>10.1016/j.ejso.2016.03.020</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Chemotherapy, Adjuvant - statistics & numerical data Colorectal liver metastases Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Disease-Free Survival Drop-out Female France Hematology, Oncology and Palliative Medicine Hepatectomy Humans Liver Neoplasms - mortality Liver Neoplasms - secondary Liver Neoplasms - surgery Male Middle Aged One-stage hepatectomy Overall survival and recurrence-free survival Patient Dropouts - statistics & numerical data Patient Selection Prognosis Retrospective Studies Surgery Surgical margin Two-stage hepatectomy |
| title | Drop-out between the two liver resections of two-stage hepatectomy. Patient selection or loss of chance? |
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