Feasibility study of two-stage hepatectomy for bilobar liver metastases

BackgroundThe aim of this study was to analyze the feasibility and early outcomes of 2-stage liver resection for bilobar metastases.MethodsData from 39 consecutive patients undergoing 2-stage hepatectomy between 2004 and 2010 were prospectively collected.ResultsThe 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%.ConclusionsTwo-stage hepatectomy is feasible, with 69% of patients achieving clearance with low mortality. Morbidity is significant, particularly transient hepatic insufficiency.