title: Two-stage hepatectomy (R0) with portal vein ligation--towards curing patients with extended bilobular colorectal liver metastases.
abstract: OBJECTIVE
  Patients with bilobular colorectal liver metastases (CRLM) experience poor prognosis, especially when curative resection cannot be achieved. However, resectability in these patients is often limited by low future remnant liver volume (FRLV). The latter can be enhanced by a two-stage liver resection, using portal vein ligation to induce liver hypertrophy. The aim of this prospective pilot study was to evaluate safety, secondary resectability, and time to recurrence of two-stage hepatectomy with portal vein ligation (PVL) and complete surgical clearance of the FRLV in patients with bilobular CRLM.
  
  
  METHODS
  Out of 24 patients (63+/-8.26 years) with extended bilobular CRLM (metachronous n=10, synchronous n=14), 18 received preoperative 5-FU-based chemotherapy combined with oxaliplatin or irinotecan. Staging included thoracoabdominal computed tomography and (18)F-fluorodeoxyglucose-positron emission tomography scans. First-stage procedure consisted of PVL, resection of all CRLM in the FRLV, and radiofrequency ablation (RFA) of CRLM situated near the future resection plane.
  
  
  RESULTS
  During first-stage procedure, 7x RFA, 4x non-anatomical resections, and 4x bisegmentectomies were performed additionally to PVL. FRLV/body-weight ratio increased from 0.4% to 0.6% within 55 days (median) after PVL. Second-stage hepatectomy was performed in 19 patients without tumor progression. R0 resection was possible in 14 patients. During a median follow-up of 17 months, intrahepatic recurrence occurred in two, and extrahepatic recurrence in nine out of 14 patients.
  
  
  CONCLUSIONS
  Two-stage hepatectomy with PVL and complete surgical clearance of FRLV is safe even after intensified systemic chemotherapy resulting in a curative resection rate of 58.3% (73.7% of re-explored cases).
authors.affiliation: Department of General and Visceral Surgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075 Göttingen, Germany. khomayounfar@chirurgie-goettingen.de
authors.forename: K
authors.initials: K
authors.lastname: Homayounfar
authors.forename: T
authors.initials: T
authors.lastname: Liersch
authors.forename: G
authors.initials: G
authors.lastname: Schuetze
authors.forename: M
authors.initials: M
authors.lastname: Niessner
authors.forename: A
authors.initials: A
authors.lastname: Goralczyk
authors.forename: J
authors.initials: J
authors.lastname: Meller
authors.forename: C
authors.initials: C
authors.lastname: Langer
authors.forename: B M
authors.initials: BM
authors.lastname: Ghadimi
authors.forename: H
authors.initials: H
authors.lastname: Becker
authors.forename: T
authors.initials: T
authors.lastname: Lorf
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D014057:Tomography, X-Ray Computed