title: Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases.
abstract: Two-stage hepatectomy has been developed as a surgical strategy for extremely difficult cases of bilobar multinodular metastatic liver disease. This strategy is applied when it is impossible to resect all malignant lesions in a single procedure. The main principle of this approach is sequential resection by a two-staged hepatectomy. Its goal is to achieve a complete metastasectomy in those cases in which a complete resection with a single hepatectomy would have left a remnant postresection liver too small for patient survival. This article describes strategic surgical approaches to multinodular metastatic disease and provides decision guidelines for two-stage hepatectomies.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94804 Villejuif, France. rene.adam@pbr.aphp.fr
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Rafael
authors.initials: R
authors.lastname: Miller
authors.forename: Marcos
authors.initials: M
authors.lastname: Pitombo
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Haas
authors.forename: Georgia
authors.initials: G
authors.lastname: Bitsakou
authors.forename: Thomas
authors.initials: T
authors.lastname: Aloia
mesh_terms: D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D011300:Preoperative Care