Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors

Objective To assess feasibility, risks, and patient outcomes in the treatment of colo rectal metastases with two-stage hepatectomy. Summary Background Data Some patients with multiple hepatic colorectal metastases are not candidate s for a complete resection by a single hepatectomy, even when downstaged by chemotherapy, after portal embolization, or combined with a locally destru ctive technique. In two-stage hepatectomy, the highest possible number of t umors is resected in a first, noncurative intervention, and the remaining t umors are resected after a period of liver regeneration. In selected patien ts with irresectable multiple metastases not amenable to a single hepatecto my procedure, two-stage hepatectomy might offer a chance of long-term remis sion. Methods Of consecutive patients with conventionally irresectable colorectal metasta ses treated by chemotherapy, 16 of 398 (4%) became eligible for curative tw o-stage hepatectomy combined with chemotherapy and adjuvant nonsurgical int erventions as indicated. Results Two-stage hepatectomy was feasible in 13 of 16 patients (81%). There were n o surgical deaths. The postoperative death rate (2 months or less) was 0% f or the first-stage procedure and 15% for the second-stage one. Postoperativ e complication rates were 31% and 45%, respectively, with only one complica tion leading to reoperation. The 3-year survival rate was 35%, with four pa tients (31%) disease-free at 7, 22, 36, and 54 months. Median survival was 31 months from the second hepatectomy and 44 months from the diagnosis of m etastases. Conclusions Two-stage hepatectomy combined with chemotherapy may allow a long-term remi ssion in selected patients with irresectable multiple metastases and increa ses the proportion of patients with resectable disease.