One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases.
BACKGROUND
Portal vein embolization (PVE), proposed to induce contralateral hepatic hypertrophy before major hepatectomy, carries some negative side effects since growth rate of metastases in the future remnant liver (RL) can be more rapid than that of nontumoral liver parenchyma. Therefore, metastases in the RL should be ideally resected before PVE, and a major hepatectomy can then be performed after PVE in patients with multiple bilobar colorectal liver metastases (MBLM). The aim of this study was to assess feasibility and outcome in patients with initially unresectable colorectal liver metastases treated by a one- or two-stage hepatectomy procedure (TSHP) combined with PVE.


METHODS
From December 1996 to December 1999, 180 patients with colorectal liver metastases underwent hepatectomy. During the same period, 18 were initially considered as unresectable. TSHP combined with PVE was attempted for 7 patients (group A) among those with MBLM, and a one-stage hepatectomy after PVE was attempted in another group of 11 patients (group B) among those with non-MBLM.


RESULTS
Nonanatomical resections for left liver metastases were performed as a first stage without any complications in group A. A right hepatectomy (RH) was performed in 5 patients in group A (feasibility = 71%). In group B, 7 of the 11 patients underwent a RH or an extended RH after PVE (feasibility = 64%). Postoperative complications rate did not differ between group A and B. Mortality was nil. Three-year survival rate was 53% in group A and 100% in group B.


CONCLUSIONS
These results suggest that one- or two-stage hepatectomy combined with PVE can be applied safely to selected patients initially considered as unresectable. Three-year survival was similar to that observed in patients with initially resectable liver metastases.
Jaeck
Daniel
D
Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Strasbourg, Avenue Molière, France. Daniel.Jaeck@chru-strasbourg.fr
Bachellier
Philippe
P
Nakano
Hiroshi
H
Oussoultzoglou
Elie
E
Weber
Jean-Christophe
JC
Wolf
Philippe
P
Greget
Michel
M
D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed