TRIPLE HEPATECTOMIES FOR CANCER

The resection of the metastases from digestive malignant lesions are a lways the most efficient treatment, if it is complete. However it must be performed without major operative risk. According to this point of view, it is logical to examine the feasibility of three successive he patectomies for metastases. We report in this study our experience wit h five cases of triple hepatectomies performed for 4 colic cancers and 1 carcinoid cancer. Two major hepatectomies were performed during thi s third resection. The re-exposure of the liver was very difficult in 4 cases, and the texture of the liver parenchyma was flabby and abnorm al in 5 cases (confirmed with the histologic study). The mean duration of the surgery was 307 minutes, the mean duration of the intermittent pedicle clamping was 59 minutes, and the mean blood loss was 1710 ml. No post-operative death occured, and the morbidity was low. This 5 th ird hepatectomies have been compared, for the feasability, to the 41 s econd hepatectomies and to the 234 first hepatectomies which we have p erformed. In proportion as hepatectomies are carried out, the difficul ties to expose the liver increase, the texture of the liver parenchyma gets spoiled and the duration of the operation increases. In conclusi on, the third hepatectomies are technically difficult to perform, but they are feasable. However it is too early to be able to define their indications.