Pamecha V, Nedjat-Shokouhi B, Gurusamy K, Glantzounis G K, Sharma D, Davidson B R
Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, and Royal Free University College Medical School, University College London, London, UK.
Dig Surg. 2008;25(5):387-93. doi: 10.1159/000176063. Epub 2008 Nov 26.
Liver resection is contraindicated in patients with multiple bilobar colorectal liver metastases because of the small liver remnant. An alternative strategy which may be curative is a two-stage hepatectomy in which the cancer is resected from one lobe and regeneration allowed prior to contralateral lobe resection.
To assess the feasibility, risks, and outcomes in a prospectively applied strategy for two-stage hepatectomy.
Over a 6-year period, 14 of 280 patients undergoing liver resection for colorectal liver metastases (5%) were considered for two-stage hepatectomy. Surgery was combined with chemotherapy in all (n = 14) and portal vein embolisation (PVE) selectively (n = 5). Median follow-up was 43 months.
Both stages were completed in 11 of 14 patients (78%). There were no deaths. Post-operative complication rates were 0% (1st hepatectomy) and 27% (2nd hepatectomy). The 5-year survival after the second hepatectomy was 50%. The mean disease-free survival was 25 +/- 7.5 months.
Two-stage hepatectomy combined with systemic chemotherapy and PVE can produce long-term survival in patients with multiple bilobar colorectal liver metastases.
由于剩余肝脏过小，多叶结直肠癌肝转移患者禁忌行肝切除术。一种可能治愈的替代策略是两阶段肝切除术，即先从一个肝叶切除肿瘤，待其再生后再行对侧肝叶切除。
评估前瞻性应用两阶段肝切除术策略的可行性、风险及结果。
在6年期间，280例行结直肠癌肝转移肝切除术的患者中有14例（5%）考虑行两阶段肝切除术。所有患者（n = 14）手术均联合化疗，5例患者选择性行门静脉栓塞术（PVE）。中位随访时间为43个月。
14例患者中有11例（78%）完成了两个阶段的手术。无死亡病例。术后并发症发生率第一阶段肝切除术为0%，第二阶段肝切除术为27%。第二次肝切除术后5年生存率为50%。平均无病生存期为25±7.5个月。
两阶段肝切除术联合全身化疗和PVE可使多叶结直肠癌肝转移患者获得长期生存。
