Comparison of two-stage hepatectomy and single-stage hepatectomy after downstaging by chemotherapy for the treatment of initially unresectable colorectal liver metastases: A meta-analysis

Aim. The aim of this study was to conduct a systematic review and meta-analysis evaluating the comparative effectiveness of two-stage hepatectomy versus single-stage hepatectomy. Methods. A literature search of Medline, EMBASE, Ovid, and Cochrane databases between 1996 and 2012 identified studies of two-stage hepatectomy (Group TS) and chemotherapeutic downstaging followed by single-stage surgery (Group SS) for initially unresectable colorectal liver metastases (CRLM). Random-effect model were used for meta-analysis. Results. Thirty-three studies met inclusion criteria, enrolling 1652 patients (Group TS, 1050, and Group SS, 602 patients). The clinical characteristics from both groups were similar. Patients in Group TS had longer postoperative length of stay, higher postoperative morbidity, and mortality but lower tumor recurrence rate (P<0.05). Disease free survival at one, three and five years (Group TS-48%, 24%, 17%, respectively; Group SS-61%, 25%, 21%, respectively) and overall survival (Group TS-87%, 59%, 39%, respectively; Group SS-91%, 57%, 42%, respectively) were equivalent, P>0.05. Conclusion. Two-stage hepatectomy for patients with initially unresectable CRLM is associated with similar outcomes to patients managed with chemotherapeutic downstaging followed by single-stage resection. Two-stage hepatectomy is a reasonable surgical strategy when curative single-stage surgery at diagnosis is not feasible.