New frontiers in liver surgery. Two-stage liver surgery for the managementof advanced metastatic liver disease

BAGKGROUND/AIMS: To assess the value and the safety of main portal branch t ransection combined with transarterial targeting locoregional neo and adjuv ant immunochemotherapy, 32 patients suffering from advanced metastatic live r disease underwent two-stage hepatectomy. METHODOLOGY: From. September 1995 to June 1999, 32 consecutive patients und erwent two-stage surgery for advanced metastatic liver disease. Firstly we performed ligation and transection of the main portal branch corresponding to the liver lobe occupied by the tumor and introduction of an arterial jet port catheter towards the hepatic artery. After a locoregional transarteri al targeting immunochemotherapy regimen the patient had a 2nd laparotomy fo r hemihepatectomy. Following surgery, locoregional targeting immunochemothe rapy was carried out in all patients via the arterial port of the gastroduo denal artery as an adjuvant treatment. RESULTS: There were no operative deaths. Mean survival was 27+/-8 months. CONCLUSIONS: Two-stage liver surgery is an appealing alternative that incre ases the resectability rate and overall survival in patients with advanced metastatic liver disease and is associated with excellent quality of post-o perative life.