title: Feasibility study of two-stage hepatectomy for bilobar liver metastases.
abstract: BACKGROUND
  The aim of this study was to analyze the feasibility and early outcomes of 2-stage liver resection for bilobar metastases.
  
  
  METHODS
  Data from 39 consecutive patients undergoing 2-stage hepatectomy between 2004 and 2010 were prospectively collected.
  
  
  RESULTS
  The median age was 59 years (range, 33-79 years), and the ratio of men to women was 1.8:1. Metastases were colorectal carcinoma (n = 33), neuroendocrine tumors (n = 3), gastrointestinal stromal tumor (n = 1), ocular melanoma (n = 1), and salivary gland carcinoma (n = 1). Perioperative chemotherapy was given to 32 patients (82%). Twenty-nine patients (74%) underwent portal venous embolization. Radiofrequency ablation was used in 8 patients (21%). Twenty-seven patients (69%) successfully completed clearance. For the 1st and 2nd stages, the median lengths of stay were 11 days (range, 6-53 days) and 13 days (range, 6-44 days), and morbidity rates were 23% and 56%. Liver insufficiency occurred in 2 (5%) and 6 (22%) patients. Overall mortality was 2.6%. For colorectal metastases, median survival in successes versus failures was 24 versus 10 months (P = .03), and 3-year survival was 30% versus 0%.
  
  
  CONCLUSIONS
  Two-stage hepatectomy is feasible, with 69% of patients achieving clearance with low mortality. Morbidity is significant, particularly transient hepatic insufficiency.
authors.affiliation: Barts and The London HPB Unit, The Royal London Hospital, London, UK. kbowers@ausdoctors.net
authors.forename: Kaye A
authors.initials: KA
authors.lastname: Bowers
authors.forename: David
authors.initials: D
authors.lastname: O'Reilly
authors.forename: Giles E
authors.initials: GE
authors.lastname: Bond-Smith
authors.forename: Robert R
authors.initials: RR
authors.lastname: Hutchins
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents