title: Laparoscopic first step approach in the two stage hepatectomy.
abstract: Resection is the gold standard therapeutic option for patients with colorectal liver metastases. However, only 20-30% of patients are resectable. In patients with a concomitant future liver remnant (FLR) less than 25-30%, a single stage resection is not feasible. The aim of this study is to evaluate the feasibility and the rates of morbidity and mortality of the laparoscopic approach in the first-step of two stage hepatectomy. From 2004 to March 2014, 73 patients underwent a two stage hepatectomy: of these, four underwent a totally laparoscopic first step [wedge left liver resection and right portal vein ligation (PVL)]. All the patients were male. Median age was 55 years. One patient underwent an atypical wedge resection of segment II-III and a laparoscopic PVL (LPVL), one patient had a first wedge resection of segment II and LPVL, and two patients underwent a wedge resection of segment III and LPVL. First step surgical mean time was 189 (range, 160-244) min, mean blood loss was 22 (range, 0-50) cc. No transfusion was required in this series. The results of our study demonstrate that the first step of hepatic resection and PVL is feasible with a laparoscopic approach in patients with bilobar liver metastases.
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Colace
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vennarecci
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santoro
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lepiane
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Colasanti
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Burocchi
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
keywords: Laparoscopic liver resection; laparoscopic portal vein ligation (LPVL); two stage hepatectomy