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Hépato-Gastro & Oncologie Digestive

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Two-stage hepatectomy for unresectable colorectal liver metastases, an effective strategy Volume 21, issue 4, Avril 2014

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Authors
Centre Léon Bérard,
Département de Chirurgie Oncologique,
28 rue Laennec,
69008 Lyon, France
* Tirés à part

Colorectal cancer is associated with liver metastases in 30% to 50% of patients. Liver resection is the only potential curative treatment, but resection is feasible only in a minority of patients. During the last decade, progresses in chemotherapy regimen associated with targeted therapies and new surgical strategies, have permitted increased resection rate. Some patients with bilobar liver metastases are considered as non-resectable when all metastases cannot be removed with sufficient future remnant liver in one stage. Two-stage hepatectomy can be proposed with a curative intent for these patients, after successful induction chemotherapy. Summarily, first stage consists of a clearance of the future remnant liver with portal vein embolization of contralateral liver. The primary tumor, if still present, can be managed at the same time. After a mean delay of two months and frequently interval chemotherapy, the second stage consists of resecting the embolized liver. Almost one patient out of four will not have the second stage, mainly because of disease progression. Nevertheless, this strategy is safe and effective with results close to those obtained after hepatectomy for resectable metastases, regarding morbidity and mortality and long-term efficacy with a 5-year overall survival of nearly 42 %.