title: Two-stage liver surgery for advanced liver metastasis synchronous with colorectal tumor.
abstract: OBJECTIVE
  To evaluate the efficacy of two-stage surgery and multidisciplinary approach, in the treatment of primary colorectal cancer, synchronous with advanced liver metastases.
  
  
  METHODS
  Sixty-two patients who underwent two-stage surgery for advanced metastatic liver disease synchronous with colorectal tumor were studied. In the first-stage surgery, the primary colorectal tumor was resected. Depending on the location of the main tumor mass, ligation and transection of the relevant (right or left) main portal vein branch was done. Subsequently, the metastatic nodules in the contralateral lobe were ablated by microwave therapy. An arterial jet port catheter was also introduced into the hepatic artery via the gastroduodenal artery for locoregional chemoimmunotherapy. Two days after the first-stage surgery locoregional transarterial targeting chemoimmunotherapy was given. The second-stage hemihepatectomy was carried out forty to forty-five days after the initial surgery. As an adjuvant treatment locoregional targeting chemoimmunotherapy was carried out in all patients via the arterial chemoport.
  
  
  RESULTS
  Mean survival was 66+/-4 months. There were no operative deaths.
  
  
  CONCLUSIONS
  Two-stage liver surgery including, portal vein branch ligation, microwave ablative therapy and transarterial targeting locoregional chemoimmunotherapy is the best treatment for advanced, synchronous metastatic liver disease of colorectal origin. It results in an increase in the overall survival of these patients with good postoperative quality of life, which encourages the hepato-biliary surgeon to venture upon this herculean task thus increasing the resectability rate of the tumor.
authors.affiliation: Department of Surgical Oncology, Henry Dunant Hospital, Athens, Greece. iasg@iasg.org
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: Gurusharan
authors.initials: G
authors.lastname: Singh
authors.forename: E
authors.initials: E
authors.lastname: Bardaxoglou
authors.forename: G
authors.initials: G
authors.lastname: Dedemadi
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: J
authors.initials: J
authors.lastname: Nestoridis
authors.forename: A
authors.initials: A
authors.lastname: Malliotakis
authors.forename: M
authors.initials: M
authors.lastname: Pedonomou
authors.forename: E K
authors.initials: EK
authors.lastname: Solomou
authors.forename: M
authors.initials: M
authors.lastname: Safioleas
authors.forename: Maria
authors.initials: M
authors.lastname: Alamani
authors.forename: L
authors.initials: L
authors.lastname: Grigorakos
authors.forename: E M
authors.initials: EM
authors.lastname: Merikas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007269:Injections, Intra-Arterial; D007459:Iodized Oil / Q000627:therapeutic use; D008026:Ligation; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007459:Iodized Oil