title: Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases.
abstract: BACKGROUND
  Despite the gradual diffusion of laparoscopic liver resection, the feasibility and results of laparoscopic two-stage hepatectomy (TSH) for bilobar colorectal liver metastases (CRLM) have not been described frequently. This study aimed to evaluate the feasibility, safety and oncological outcomes of laparoscopic TSH for bilobar CRLM.
  
  
  METHODS
  All patients eligible for laparoscopic TSH among those treated for bilobar CRLM from 2000 to 2013 were included. Demographics, tumour characteristics, surgical procedures, and short- and long-term outcomes were analysed.
  
  
  RESULTS
  Laparoscopic TSH was planned in 34 patients with bilobar CRLM, representing 17·2 per cent of all 198 patients treated for bilobar CRLM. Thirty patients received preoperative chemotherapy, and 20 had portal vein occlusion to increase the volume of the remnant liver. Laparoscopic resection of the primary colorectal tumour was integrated within the first-stage hepatectomy in 11 patients. After a median interval of 3·1 months, 26 patients subsequently had a successful laparoscopic second-stage hepatectomy, including 18 laparoscopic right or extended right hepatectomies. The mortality rate for both stages was 3 per cent (1 of 34), and the overall morbidity rate for the first and second stages was 50 per cent (17 of 34) and 54 per cent (14 of 26) respectively. Mean length of hospital stay was 6·1 and 9·0 days respectively. With a median follow-up of 37·8 (range 6-129) months, 3- and 5-year overall survival rates in patients who completed TSH were 78 and 41 per cent respectively. The 3- and 5-year disease-free survival rates were 26 and 13 per cent respectively.
  
  
  CONCLUSIONS
  Laparoscopic TSH for bilobar CRLM is safe and does not jeopardize long-term outcomes in selected patients.
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Department of Surgery, Nara Medical University, Nara, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ogiso
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Gelli
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Velayutham
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.|Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: C
authors.initials: C
authors.lastname: Conrad
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Louvet
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Gayet
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome