title: Two-stage resection for bilobar colorectal liver metastases: R0 resection is the key.
abstract: BACKGROUND
  Two-stage liver resection (2-SLR) is used clinically in conjunction with portal vein embolization for bilobar disease to increase the number of patients suitable for liver resection. The long-term outcomes after 2-SLR for multiple bilobar colorectal liver metastases (CLM) was examined.
  
  
  METHODS
  Patients who sought care between November 2003 and April 2006 with multiple CLM considered suitable for 2-SLR were prospectively followed. Clinicopathological data were collected. Surgical outcomes were defined as complete clearance of tumor (R0/R1/R2), postoperative morbidity (within 3 months), 30 day mortality, disease-free survival (DFS), and overall survival (OS).
  
  
  RESULTS
  A total of 131 patients with CLM underwent liver resection during the study period, 38 of whom were planned for a 2-SLR for multiple bilobar disease. Only 33 (87%) completed the 2-SLR with a curative intent. Five patients did not undergo stage II resection because of disease progression. The postoperative morbidity was 11 and 33% after stage I and stage II liver resections, respectively. Five patients (13%) encountered postoperative complications specific to liver surgery. The median interval from stage II resection to disease recurrence in the R0 group was 18 months versus 3 months in the R1/R2 group (P < 0.001). R0 resection with curative intent versus R1/R2 noncurative resection has a significantly longer period of DFS (P < 0.001) and OS (P = 0.04).
  
  
  CONCLUSIONS
  The 2-SLR combined with portal vein embolization is an effective and safe method for resecting previously unresectable multiple bilobar CLM. However, a positive resection margin leads to poor DFS and OS.
authors.affiliation: Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, London, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Tsim
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Healey
authors.forename: Adam E
authors.initials: AE
authors.lastname: Frampton
authors.forename: Nagy A
authors.initials: NA
authors.lastname: Habib
authors.forename: Devinder S
authors.initials: DS
authors.lastname: Bansi
authors.forename: Harpreet
authors.initials: H
authors.lastname: Wasan
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Cleator
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Charles P
authors.initials: CP
authors.lastname: Lowdell
authors.forename: James E
authors.initials: JE
authors.lastname: Jackson
authors.forename: Paul
authors.initials: P
authors.lastname: Tait
authors.forename: Long R
authors.initials: LR
authors.lastname: Jiao
mesh_terms: D000368:Aged; D017115:Catheter Ablation; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome