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Ann Surg. 2000 Dec;232(6):777-85.

Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors.

Author information

1
Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, and Université Paris-Sud, France. rene.adam@pbr.ap-hop-paris.fr

Abstract

OBJECTIVE:

To assess feasibility, risks, and patient outcomes in the treatment of colorectal metastases with two-stage hepatectomy.

SUMMARY BACKGROUND DATA:

Some patients with multiple hepatic colorectal metastases are not candidates for a complete resection by a single hepatectomy, even when downstaged by chemotherapy, after portal embolization, or combined with a locally destructive technique. In two-stage hepatectomy, the highest possible number of tumors is resected in a first, noncurative intervention, and the remaining tumors are resected after a period of liver regeneration. In selected patients with irresectable multiple metastases not amenable to a single hepatectomy procedure, two-stage hepatectomy might offer a chance of long-term remission.

METHODS:

Of consecutive patients with conventionally irresectable colorectal metastases treated by chemotherapy, 16 of 398 (4%) became eligible for curative two-stage hepatectomy combined with chemotherapy and adjuvant nonsurgical interventions as indicated.

RESULTS:

Two-stage hepatectomy was feasible in 13 of 16 patients (81%). There were no surgical deaths. The postoperative death rate (2 months or less) was 0% for the first-stage procedure and 15% for the second-stage one. Postoperative complication rates were 31% and 45%, respectively, with only one complication leading to reoperation. The 3-year survival rate was 35%, with four patients (31%) disease-free at 7, 22, 36, and 54 months. Median survival was 31 months from the second hepatectomy and 44 months from the diagnosis of metastases.

CONCLUSIONS:

Two-stage hepatectomy combined with chemotherapy may allow a long-term remission in selected patients with irresectable multiple metastases and increases the proportion of patients with resectable disease.

PMID:
11088072
PMCID:
PMC1421270
DOI:
10.1097/00000658-200012000-00006
[Indexed for MEDLINE]
Free PMC Article

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