Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases.

Two-stage hepatectomy has been developed as a surgical strategy for extremely difficult cases of bilobar multinodular metastatic liver disease. This strategy is applied when it is impossible to resect all malignant lesions in a single procedure. The main principle of this approach is sequential resection by a two-staged hepatectomy. Its goal is to achieve a complete metastasectomy in those cases in which a complete resection with a single hepatectomy would have left a remnant postresection liver too small for patient survival. This article describes strategic surgical approaches to multinodular metastatic disease and provides decision guidelines for two-stage hepatectomies.