Regeneration after two-stage hepatectomy vs. repeat resection for colorectal metastasis recurrence.
BACKGROUND
Two-stage hepatectomy aims to minimize liver failure risk by performing a second resection after regeneration, assuming that remnant liver hypertrophy after the second resection is similar to that seen in repeat hepatectomy, yet the impact of a two-stage strategy on liver volume and function remains to be demonstrated.


METHODS
Twenty patients undergoing two-stage hepatectomy for multiple colorectal cancer metastases and 21 patients with more than two sections of liver parenchyma totally removed by repeat liver resections for recurrence were enrolled. Liver volumes after final hepatectomy and postoperative liver function were compared.


RESULTS
Median total liver volumes before initial hepatectomy and after final hepatectomy of multiple resections were 942 and 863 ml in patients with repeat hepatectomy, whereas volumes at corresponding time points were 957 and 777 ml in patients with two-stage hepatectomy. The ratio of total liver volume after both hepatectomies to preoperative volume in the two-stage group (81.7%) was lower than that in the repeat resection group (92.0%, P = 0.027). Greater aspartate aminotransferase and prothrombin time and lower platelet count 1 month postoperatively and lower albumin at 6 months were evident after two-stage hepatectomy compared with repeat hepatectomy.


CONCLUSIONS
Two-stage hepatectomy is characterized by diminished hepatic regenerative capacity and postoperative liver function.
Tanaka
Kuniya
K
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Japan. ktrj112@urahp.yokohama-cu.ac.jp
Shimada
Hiroshi
H
Matsuo
Kenichi
K
Ueda
Michio
M
Endo
Itaru
I
Togo
Shinji
S
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology / Q000601:surgery*; D009929:Organ Size; D011184:Postoperative Period; D012189:Retrospective Studies
D001219:Aspartate Aminotransferases