title: New frontiers in liver surgery. Two-stage liver surgery for the management of advanced metastatic liver disease.
abstract: OBJECTIVE
  To assess the value and the safety of main portal branch transection combined with transarterial targeting locoregional neo and adjuvant immunochemotherapy, 32 patients suffering from advanced metastatic liver disease underwent two-stage hepatectomy.
  
  
  METHODS
  From September 1995 to June 1999, 32 consecutive patients underwent two-stage surgery for advanced metastatic liver disease. Firstly we performed ligation and transection of the main portal branch corresponding to the liver lobe occupied by the tumor and introduction of an arterial jet port catheter towards the hepatic artery. After a locoregional transarterial targeting immunochemotherapy regimen the patient had a 2nd laparotomy for hemihepatectomy. Following surgery, locoregional targeting immunochemotherapy was carried out in all patients via the arterial port of the gastroduodenal artery as an adjuvant treatment.
  
  
  RESULTS
  There were no operative deaths. Mean survival was 27 +/- 8 months.
  
  
  CONCLUSIONS
  Two-stage liver surgery is an appealing alternative that increases the resectability rate and overall survival in patients with advanced metastatic liver disease and is associated with excellent quality of post-operative life.
authors.affiliation: Athens Medical Center, Apollonio Hospital, Greece.
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: L
authors.initials: L
authors.lastname: Vlachos
authors.forename: S
authors.initials: S
authors.lastname: Raptis
authors.forename: G
authors.initials: G
authors.lastname: Rassidakis
authors.forename: C
authors.initials: C
authors.lastname: Balaskas
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: D
authors.initials: D
authors.lastname: Mourikis
authors.forename: D
authors.initials: D
authors.lastname: Kehagias
authors.forename: C
authors.initials: C
authors.lastname: Kittas
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed