V Pamecha1, B Nedjat-Shokouhi, K Gurusamy, G K Glantzounis, D Sharma, B R Davidson. 1. Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, and Royal Free University College Medical School, University College London, London, UK.
Abstract
BACKGROUND: Liver resection is contraindicated in patients with multiple bilobar colorectal liver metastases because of the small liver remnant. An alternative strategy which may be curative is a two-stage hepatectomy in which the cancer is resected from one lobe and regeneration allowed prior to contralateral lobe resection. OBJECTIVE: To assess the feasibility, risks, and outcomes in a prospectively applied strategy for two-stage hepatectomy. METHODS: Over a 6-year period, 14 of 280 patients undergoing liver resection for colorectal liver metastases (5%) were considered for two-stage hepatectomy. Surgery was combined with chemotherapy in all (n = 14) and portal vein embolisation (PVE) selectively (n = 5). Median follow-up was 43 months. RESULTS: Both stages were completed in 11 of 14 patients (78%). There were no deaths. Post-operative complication rates were 0% (1st hepatectomy) and 27% (2nd hepatectomy). The 5-year survival after the second hepatectomy was 50%. The mean disease-free survival was 25 +/- 7.5 months. CONCLUSION: Two-stage hepatectomy combined with systemic chemotherapy and PVE can produce long-term survival in patients with multiple bilobar colorectal liver metastases.
BACKGROUND: Liver resection is contraindicated in patients with multiple bilobar colorectal liver metastases because of the small liver remnant. An alternative strategy which may be curative is a two-stage hepatectomy in which the cancer is resected from one lobe and regeneration allowed prior to contralateral lobe resection. OBJECTIVE: To assess the feasibility, risks, and outcomes in a prospectively applied strategy for two-stage hepatectomy. METHODS: Over a 6-year period, 14 of 280 patients undergoing liver resection for colorectal liver metastases (5%) were considered for two-stage hepatectomy. Surgery was combined with chemotherapy in all (n = 14) and portal vein embolisation (PVE) selectively (n = 5). Median follow-up was 43 months. RESULTS: Both stages were completed in 11 of 14 patients (78%). There were no deaths. Post-operative complication rates were 0% (1st hepatectomy) and 27% (2nd hepatectomy). The 5-year survival after the second hepatectomy was 50%. The mean disease-free survival was 25 +/- 7.5 months. CONCLUSION: Two-stage hepatectomy combined with systemic chemotherapy and PVE can produce long-term survival in patients with multiple bilobar colorectal liver metastases.
Authors: Christoph Reissfelder; Nuh N Rahbari; L Urrutia Bejarano; Thomas Schmidt; Nikolas Kortes; Hans-Ulrich Kauczor; Markus W Büchler; Jürgen Weitz; Moritz Koch Journal: Langenbecks Arch Surg Date: 2014-03-11 Impact factor: 3.445
Authors: Antoine Brouquet; Eddie K Abdalla; Scott Kopetz; Christopher R Garrett; Michael J Overman; Cathy Eng; Andreas Andreou; Evelyne M Loyer; David C Madoff; Steven A Curley; Jean-Nicolas Vauthey Journal: J Clin Oncol Date: 2011-01-24 Impact factor: 44.544
Authors: Riccardo Memeo; Vito de Blasi; René Adam; Diane Goéré; Daniel Azoulay; Ahmet Ayav; Emilie Gregoire; Reza Kianmanesh; Francis Navarro; Antonio Sa Cunha; Patrick Pessaux Journal: HPB (Oxford) Date: 2016-07-05 Impact factor: 3.647
Authors: Vincent W T Lam; Jerome M Laurence; Emma Johnston; Michael J Hollands; Henry C C Pleass; Arthur J Richardson Journal: HPB (Oxford) Date: 2012-11-07 Impact factor: 3.647