Two-step surgery for synchronous bilobar liver metastases from digestive endocrine tumors: a safe approach for radical resection.
OBJECTIVE
We describe the early and distant results of a 2-step surgical strategy that enables complete resection in selected patients with primary digestive endocrine tumors (DET) and synchronous bilobar liver metastases (LM).


BACKGROUND
Frequent synchronous and bilobar liver involvement limits indications of surgery in LM from DET.


METHODS
From 1996 to 2004, of 41 patients with synchronous bilobar LM from DET, 23 (56%) were selected for 2-step surgery. The first step included resection of the primary tumor and limited (nonanatomic) resection of left LM (segments 1-4) associated with a right portal vein ligation. After 8 weeks, following hypertrophy of the cleared left liver, a right or extended right hepatectomy was planned.


RESULTS
At the first step, all primary tumors (bowel = 12, distal pancreas = 10, rectal = 1) were resected and LM were resected in 20 patients (87%). One patient did not have second-step due to tumor progression. The second step (n = 19; 83%) was performed after a median interval of 8 weeks (range, 6-13) and a 54 +/- 21% mean left liver hypertrophy rate. Postoperatively, 4 (17%) and 4 (21%) patients developed nonlethal complications and the median hospital stay was 11 (range, 7-26) and 13 (range, 9-17) days after the first and the second step, respectively. The median number of resected LM was 4 (range, 1-9) and 7 (range, 4-17), respectively. With a median follow-up of 64 months (range, 6-122), of the 19 patients who had complete 2-step surgery, all except one are alive. The 2-, 5-, and 8-year Kaplan-Meier overall and disease-free survival rates were 94%, 94%, 79% and 85%, and 50% and 26%, respectively.


CONCLUSIONS
This 2-step surgery approach enables complete resection with no mortality, acceptable morbidity, and good long-term survival in selected patients with synchronous bilobar LM from DET.
Kianmanesh
Reza
R
Department of Hepato-Biliary,AP-HP, Beaujon Hospital, Clichy, France.
Sauvanet
Alain
A
Hentic
Olivia
O
Couvelard
Anne
A
Lévy
Philippe
P
Vilgrain
Valérie
V
Ruszniewski
Philippe
P
Belghiti
Jacques
J
D000328:Adult; D000368:Aged; D004067:Digestive System Neoplasms / Q000473:pathology / Q000601:surgery*; D004701:Endocrine Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome