Multiple bilobar colorectal liver metastases (CLM) is a big challenge for surgeon oncologist due to high risk of postoperative morbidity and mortality. Two-stage hepatectomy (TSH) is a nowadays surgical standard. As alternative enhanced one-stage hepatectomy (e-OSH) with intraoperative ultrasound control to reduce the resection of the unaffected parenchyma could be performed.
665 patients with CLM who underwent liver resection at the Privolzhsky District Medical Center from 2010 to 2017 were retrospectively analyzed. Inclusion criteria were multiple CLM in one lobe with at least one lesion in the contralateral lobe. 76 patients (11,5%) were included in the study: 49 with TSH and 27 with e-OSH. Post-operative complications rate and overall survival in 2 groups were investigated and compared.
Among 49 patients in first group (TSH) 23 reached to the second stage. Drop-out rate of TSH was 53%. Compared to the e-OSH patients who reached to the second stage had similar overall morbidity (TSH – 30.4% vs. e-OSH – 33.3% p = 0.827), liver-specific morbidity (TSH – 17.4% vs. e-OSH – 29.6%, p = 0.313) severe morbidity (TSH – 21.7% vs. e-OSH – 22.2% p = 0.968) and overall mortality (TSH – 8,7% vs. e-OSH – 14,8% p = 0.507). R0 resection rate was similar between groups. Completed TSH and e-OSH had similar overall survival rate (1-year 83% vs. 73% р = 0.313; 3-year 39% vs. 38% р = 0.880).
e-OSH may be considered as the surgical treatment of choice due to the absence of drop-out risk and a similar to TSH rate of morbidity, mortality, and overall survival. TSH is preferable to perform in cases where postoperative fatal liver insufficiency is highly likely.
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