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Updated: May 25, 2026
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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Two-stage hepatectomy: who will not jump over the second hurdle?
1Department of Surgical Oncology, Institut Paoli Calmettes and Université de la Méditerranée, 232 Boulevard Sainte Marguerite, 13009 Marseille, France. oturrini@yahoo.fr
Summary
Resecting primary colorectal cancer during the first stage of two-stage hepatectomy for liver metastasis may hinder the second curative surgery. This finding suggests careful consideration of surgical timing for colorectal liver metastasis (CLM) treatment.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Colorectal Cancer Management
Background:
- Two-stage hepatectomy is a strategy for bilobar colorectal liver metastasis (CLM) involving liver regeneration after an initial noncurative resection.
- This approach aims to enable a subsequent curative resection.
Purpose of the Study:
- To identify predictive factors associated with the failure of the two-stage hepatectomy procedure.
- To evaluate the impact of combined primary tumor resection and chemotherapy on the success of the second hepatectomy.
Main Methods:
- A cohort of 48 patients with unresectable CLM undergoing a planned two-stage hepatectomy between 2000 and 2010 was analyzed.
- The study involved an initial left hepatic lobe resection, followed by right portal vein embolization, and a planned right hepatectomy.
Main Results:
- Univariate analysis revealed that combining primary tumor resection during the first hepatectomy and chemotherapy administration between stages were significant factors predicting failure to complete the second hepatectomy.
- Multivariate analysis confirmed that combined resection of the primary colorectal cancer during the first hepatectomy independently impaired the ability to perform the second-stage surgery.
Conclusions:
- The study suggests that performing an isolated colorectal resection before chemotherapy may not be advisable due to potential negative impacts on the two-stage hepatectomy success.
- Resection of an asymptomatic primary tumor before chemotherapy, however, should not be dismissed as an obsolete procedure, warranting further investigation.
