title: Two-stage hepatectomy for multiple bilobular liver metastases from colorectal cancer.
abstract: OBJECTIVE
  To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of two-stage hepatectomy in patients with multiple bilobular liver metastases from colorectal carcinoma.
  
  
  METHODS
  Some patients with multiple liver metastases are not candidates for a complete resection by a single hepatectomy, even when downstaged by chemotherapy, after portal embolization. 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. Two-stage hepatectomy was performed in 11 patients.
  
  
  RESULTS
  Two-stage hepatectomy was feasible in all of the 11 patients. In 3 of them, the first stage was a major resection (more extensive than a lobectomy). This first hepatectomy was uneventful in all patients. The second hepatectomy was also uneventful in nine patients, but in one of the other two, a perihepatic fluid infection occurred, and in the other, postoperative liver failure developed due to a right subphrenic abscess. However, all patients were discharged. The percentage of the expected resection volume at one time, calculated from CT volumetry, was 75.5+/-1.2% and the prognostic score as surgical risk was 56.6+/-4.5. In two-stage hepatectomy cases, the percentage of the resected volume and the prognostic score in the first hepatectomy were 25.4+/-6.4% and 6.7+/-7.3, and in the second, 45.7+/-4.5% and 28.5+/-5.8. During the follow-up procedures, a residual hepatic recurrence was observed in 6 patients, and pulmonary recurrence in 9. The 1- and 3-year survival rates after the first hepatectomy were 90% and 45%, with median survivals of 18 months from the first hepatectomy.
  
  
  CONCLUSIONS
  Two-stage hepatectomy is a surgical modality intended for patients with initial unresectable metastases. However, following such surgery, protective treatment against residual liver recurrence and lung metastasis will be a most important issue.
authors.affiliation: Department of Surgery II, Yokohama City University, Yokohama, Japan. togo@med.yokohama-cu.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Masui
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Miura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ike
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D018570:Risk Assessment; D015996:Survival Rate