Two-Stage Hepatectomy Procedure to Treat Initially Unresectable Multiple Bilobar Colorectal Liver Metastases: Technical Aspects

Abstract

A two-stage hepatectomy procedure is a therapeutic strategy for patients presenting with initially unresectable multiple and bilobar colorectal liver metastases in order to achieve a curative R0 resection. The main goal of this approach is to minimize the risk of postoperative liver failure resulting from a too small remnant liver after completing a curative resection. This procedure combines two sequential liver resections that involve perioperative chemotherapy and portal vein embolization. This article describes our standardized strategy of two-stage hepatectomy combined with portal vein embolization used over the last 15 years and discusses the alternative procedures as well as their respective advantages and drawbacks.

Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers

“…However, the 2 groups were comparable in terms of metastases number and distribution. Second, TSH is a standardized procedure validated by different groups [5, 10, 11, 14, 15, 37, 38, 50, 51], while E-OSH not yet. At the HRH center, E-OSH is commonly performed by all the staff surgeons, but its reproducibility and learning curve remain to be assessed and require external validation.…”

Resection for Colorectal Liver Metastases

“…Intraoperative ablation extends the limits of hepatectomy in the patients not amenable to complete resection (Brown et al, 2011;Govindarajan et al, 2011;Hammill et al, 2011;Hompes et al, 2011). Portal vein embolization, radiofrequency ablation, two-stage hepatectomy, conversion therapy and reverse treatment strategy along with hepatectomy are used in the presence of extrahepatic disease (Coimbra et al 2011;Narita et al, 2011, Tsim et al, 2011. Resection of advanced colorectal liver metastases after a second-line chemotherapy regimen is safe and promising in certain cases.…”

The Assessment and Management of Chemotherapy Associated Liver Injury

“…Of the 61 patients who were treated successfully by a two stage approach 11 went on to have a sub-sequent resection of lung metastases although this had no effect on overall survival when compared to the 50 patients who did not. [92] Figure 2. Typical MRI scan of patient with bilobar disease who would be considered suitable for a two staged approach to liver resection.…”