title: Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases.
abstract: BACKGROUND
  Liver resection is contraindicated in patients with multiple bilobar colorectal liver metastases because of the small liver remnant. An alternative strategy which may be curative is a two-stage hepatectomy in which the cancer is resected from one lobe and regeneration allowed prior to contralateral lobe resection.
  
  
  OBJECTIVE
  To assess the feasibility, risks, and outcomes in a prospectively applied strategy for two-stage hepatectomy.
  
  
  METHODS
  Over a 6-year period, 14 of 280 patients undergoing liver resection for colorectal liver metastases (5%) were considered for two-stage hepatectomy. Surgery was combined with chemotherapy in all (n = 14) and portal vein embolisation (PVE) selectively (n = 5). Median follow-up was 43 months.
  
  
  RESULTS
  Both stages were completed in 11 of 14 patients (78%). There were no deaths. Post-operative complication rates were 0% (1st hepatectomy) and 27% (2nd hepatectomy). The 5-year survival after the second hepatectomy was 50%. The mean disease-free survival was 25 +/- 7.5 months.
  
  
  CONCLUSIONS
  Two-stage hepatectomy combined with systemic chemotherapy and PVE can produce long-term survival in patients with multiple bilobar colorectal liver metastases.
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, and Royal Free University College Medical School, University College London, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Pamecha
authors.forename: B
authors.initials: B
authors.lastname: Nedjat-Shokouhi
authors.forename: K
authors.initials: K
authors.lastname: Gurusamy
authors.forename: G K
authors.initials: GK
authors.lastname: Glantzounis
authors.forename: D
authors.initials: D
authors.lastname: Sharma
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome