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Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases

Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases
Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases
BACKGROUND: The role of laparoscopy in two-stage hepatectomy for bilobar colorectal liver metastases (CRLMs) has not yet been extensively investigated.

PATIENTS AND METHODS: We reviewed a prospectively collected database of 302 consecutive patients undergoing laparoscopic liver resection at our institution between 2003 and 2011.

RESULTS: Eight patients undergoing laparoscopic first/second-stage hepatectomy for bilobar CRLMs (male/female 6:2; median age, 64 years) were analyzed. The first stage consisted of laparoscopic clearance of the left lobe in all patients with no postoperative morbidity and mortality. Seven patients underwent portal vein embolization or ligation. The median interval between first- and second-stage hepatic resections was 89 days (range, 36-123 days). Second-stage hepatectomy with right lobar clearance (open, n=5; laparoscopic, n=2; laparoscopic to open, n=1) was associated with no mortality and an operative morbidity rate of 50%. Adhesions were judged to be minimal or absent during the second-stage procedure. Complications included intra-abdominal collection (n=2), bleeding requiring re-operation (n=1), and bile leak (n=1). R0 resection was obtained in 7 of 8 cases after first-stage resection and in 8 of 8 cases after second-stage resection. Three patients (38%) died from disease recurrence. Of the remaining 5 patients, 4 are disease-free at a median follow-up of 24 months (range, 9-27 months).

CONCLUSIONS: The well-recognized advantages of laparoscopy may play a favorable role in the management of patients with bilobar CRLMs candidate for a two-stage resection. The first-stage laparoscopic clearance of the left lobe could progressively become the "gold standard." Laparoscopic second-stage hepatectomy should be limited to selected cases.
1092-6429
647-650
Di Fabio, Francesco
5318ae30-aac4-49ab-b11c-289ae2049cdf
Whistance, Robert
3653139e-e6f4-437e-a299-ec01698a8fab
Rahman, Saqib
a2228883-fb64-4f47-8fd0-1a9832d04467
Primrose, John N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47
Di Fabio, Francesco
5318ae30-aac4-49ab-b11c-289ae2049cdf
Whistance, Robert
3653139e-e6f4-437e-a299-ec01698a8fab
Rahman, Saqib
a2228883-fb64-4f47-8fd0-1a9832d04467
Primrose, John N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47

Di Fabio, Francesco, Whistance, Robert, Rahman, Saqib, Primrose, John N., Pearce, Neil W. and Abu Hilal, Mohammed (2012) Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases. Journal of Laparoendoscopic & Advanced Surgical Techniques, 22 (7), 647-650. (doi:10.1089/lap.2012.0163). (PMID:22823416)

Record type: Article

Abstract

BACKGROUND: The role of laparoscopy in two-stage hepatectomy for bilobar colorectal liver metastases (CRLMs) has not yet been extensively investigated.

PATIENTS AND METHODS: We reviewed a prospectively collected database of 302 consecutive patients undergoing laparoscopic liver resection at our institution between 2003 and 2011.

RESULTS: Eight patients undergoing laparoscopic first/second-stage hepatectomy for bilobar CRLMs (male/female 6:2; median age, 64 years) were analyzed. The first stage consisted of laparoscopic clearance of the left lobe in all patients with no postoperative morbidity and mortality. Seven patients underwent portal vein embolization or ligation. The median interval between first- and second-stage hepatic resections was 89 days (range, 36-123 days). Second-stage hepatectomy with right lobar clearance (open, n=5; laparoscopic, n=2; laparoscopic to open, n=1) was associated with no mortality and an operative morbidity rate of 50%. Adhesions were judged to be minimal or absent during the second-stage procedure. Complications included intra-abdominal collection (n=2), bleeding requiring re-operation (n=1), and bile leak (n=1). R0 resection was obtained in 7 of 8 cases after first-stage resection and in 8 of 8 cases after second-stage resection. Three patients (38%) died from disease recurrence. Of the remaining 5 patients, 4 are disease-free at a median follow-up of 24 months (range, 9-27 months).

CONCLUSIONS: The well-recognized advantages of laparoscopy may play a favorable role in the management of patients with bilobar CRLMs candidate for a two-stage resection. The first-stage laparoscopic clearance of the left lobe could progressively become the "gold standard." Laparoscopic second-stage hepatectomy should be limited to selected cases.

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Published date: 23 July 2012
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 350703
URI: https://eprints.soton.ac.uk/id/eprint/350703
ISSN: 1092-6429
PURE UUID: 9cdd9263-d0b1-48f4-8c27-fae3aee01ce8
ORCID for John N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 28 Mar 2013 15:55
Last modified: 16 Jun 2018 00:36

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Contributors

Author: Francesco Di Fabio
Author: Robert Whistance
Author: Saqib Rahman
Author: Neil W. Pearce
Author: Mohammed Abu Hilal

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