Two Stage Hepatectomy

Two-stage hepatectomy is a method to increase resectability in multiple liver metastases involving both hepatic lobes and was described for the first time by Adam et al. [61]. This procedure consists in a surgical strategy that includes two different phas-

Table 8. Site of tumour recurrence after resection

Recurrence site Frequency (%)

Table 8. Site of tumour recurrence after resection

Recurrence site Frequency (%)

Liver (total)

48

Only liver

41

Liver/peritoneum

2

Liver/lung

5

Lung (total)

26

Only lung

4

Bone

4

Brain

2

Other sites

26

es. In the first phase the highest number of metastases are removed, preferably removing metastases completely in one lobe, but not all of them. In the second phase, after hypertrophy of the remnant liver, the second liver resection with curative intent is performed.

Usually patients are submitted to chemotherapy to control tumour growth after the first liver resection. Some Authors suggest beginning this treatment after at least 3 weeks in order to avoid interference with initial liver regeneration [61].

Two-stage hepatectomy should not be considered when radical resection is not possible even with the second liver resection. The aim of this procedure is to reduce the risk of post-operative liver failure, as the second liver resection is performed only after adequate hypertrophy of remnant liver.

Two-stage hepatectomy may be associated with PVE or with intraoperative ligation of portal vein of one lobe.

The most appropriate timing for the second hepatic resection takes into account the functioning of liver regeneration and the extent of the planned resection: 1-2 months are usually necessary to achieve 80% hepatic regeneration.

Results of this procedure are good, with a 3-year survival of 35% for patients submitted to radical second liver resection, whereas post-operative mortality is still high and reaches 15% after the second hepatectomy [61].

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