title: Regeneration after two-stage hepatectomy vs. repeat resection for colorectal metastasis recurrence.
abstract: 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.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Yokohama, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: 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
chemical_list: D001219:Aspartate Aminotransferases