Citation Information :
Takahashi Y, Tanaka K, Wakabayshi T, Shiozawa T. Laparoscopic First-stage Approach in a Two-stage Hepatectomy for Bilobar Colorectal Liver Metastases. World J Lap Surg 2021; 14 (2):90-94.
Aim: We reviewed a retrospectively collected database of 64 patients undergoing two-stage hepatectomy for colorectal liver metastases with special attention to cases involving a laparoscopic first stage.
Materials and methods: Three patients undergoing laparoscopic first-stage hepatectomy were analyzed and compared with 61 other patients who underwent two-stage hepatectomy using open surgery for the first stage.
Results: In three patients with a laparoscopic approach, the first-stage operation was a laparoscopic lateral sectionectomy or resection of segment 3, combined with portal vein embolization via the iliac vein directed at the contralateral hemiliver. No postoperative morbidity or mortality resulted. After a mean interval of 37.3 days, second-stage hepatectomy was performed for clearance of tumors in the right hemiliver (two in an open approach and one in a hybrid laparoscopic and open approach), with morbidity in 67% of patients (Clavien–Dindo classes I and IIIb in one patient each) but no mortality. When these three patients were compared with 61 patients treated with an open approach, numbers of metastatic tumors tended to be less in patients with a laparoscopic first stage. Duration of the first-stage hepatectomy (p <0.01) and hospital stay after that hepatectomy were shorter in patients with laparoscopic resection than in patients with open resection (p = 0.03).
Conclusion: Our preliminary data support the feasibility and safety of the laparoscopic approach for the first-stage resection during two-stage hepatectomy.
Clinical significance: First-stage laparoscopic clearance for patients with relatively small numbers of tumors who are anticipating two-stage hepatectomy for bilobar metastases becomes a standard option.
Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 2000;232(6):777–785. DOI: 10.1097/00000658-200012000-00006.
Jaeck D, Oussoultzoglou E, Rosso E, et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 2004;240(6):1037–1049. DOI: 10.1097/01.sla.0000145965.86383.89.
Chun YS, Vauthey JN, Ribero D, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg 2007;11(11):1498–1504. DOI: 10.1007/s11605-007-0272-2.
de Haas RJ, Wicherts DA, Flores E, et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 2008;248(4):626–637. DOI: 10.1097/SLA.0b013e31818a07f1.
Wicherts DA, Miller R, de Haas RJ, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 2008;248(6):994–1005. DOI: 10.1097/SLA.0b013e3181907fd9.
Yamanaka N, Okamoto E, Oriyama T, et al. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg 1994;219(4):342–346. DOI: 10.1097/00000658-199404000-00003.
Nitta H, Sasaki A, Fujita T, et al. Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg 2010;251(3):450–453. DOI: 10.1097/SLA.0b013e3181cf87da.
Terminology Committee of the International Hepato-Pancreato-Biliary Association. The Brisbane 2000 terminology of liver anatomy and resection. HPB 2000;2(3):333–339. DOI: 10.1016/S1365-182X(17)30755-4.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–213. DOI: 10.1097/01.sla.0000133083.54934.ae.
Pamecha V, Nedjat-Shokouhi B, Gurusamy K, et al. Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases. Dig Surg 2008;25(5):387–393. DOI: 10.1159/000176063.
Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol 2015;41(4):506–512. DOI: 10.1016/j.ejso.2015.01.031.
Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006;243(1):1–7. DOI: 10.1097/01.sla.0000193603.26265.c3.
Tranchart H, Dagher I. Laparoscopic liver resection: a review. J Visc Surg 2014;151(2):107–115. DOI: 10.1016/j.jviscsurg.2013.10.003.
Zhou Y, Xiao Y, Wu L, et al. Laparoscopic liver resection as a safe and efficacious alternative to open resection for colorectal liver metastasis: a meta-analysis. BMC Surg 2013;13:44. DOI: 10.1186/1471-2482-13-44.
Mirnezami R, Mirnezami AH, Chandrakumaran K, et al. Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB (Oxford) 2011;13(5): 295–308. DOI: 10.1111/j.1477-2574.2011.00295.x.
Di Fabio F, Whistance R, Rahman S, et al. Exploring the role of laparoscopic surgery in two-stage hepatectomy for bilobar colorectal liver metastases. J Laparoendosc Adv Surg Tech A 2012;22(7):647–650. DOI: 10.1089/lap.2012.0163.
Levi Sandri GB, Colace L, Vennarecci G, et al. Laparoscopic first step approach in the two stage hepatectomy. Hepatobiliary Surg Nutr 2015;4(5):345–347. DOI: 10.3978/j.issn.2304-3881.2015.01.13.
Fuks D, Nomi T, Ogiso S, et al. Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases. Br J Surg 2015;102(13):1684–1690. DOI: 10.1002/bjs.9945.
Kilburn DJ, Chiow AK, Lewin J, et al. Laparoscopic approach to a planned two-stage hepatectomy for bilobar colorectal liver metastases. ANZ J Surg 2016;86(10):811–815. DOI: 10.1111/ans.12748.
Okumura S, Goumard C, Gayet B, et al. Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: a bi-institutional, propensity score-matched study. Surgery 2019;166(6):959–966. DOI: 10.1016/j.surg.2019.06.019.