Laparoscopic first step approach in the two stage hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Resection is the primary treatment for colorectal liver metastases, but only 20-30% of patients are eligible.
• Limited future liver remnant (FLR) often precludes single-stage resection.
• Two-stage hepatectomy is an alternative for extensive bilobar disease.

Purpose of the Study:

• To assess the feasibility, morbidity, and mortality of a laparoscopic approach for the first stage of two-stage hepatectomy.
• To evaluate this technique in patients with colorectal liver metastases and insufficient FLR.

Main Methods:

• Retrospective analysis of 73 patients undergoing two-stage hepatectomy from 2004 to March 2014.
• Four patients underwent a totally laparoscopic first step: wedge liver resection and portal vein ligation (PVL).
• Procedures included segment II-III or segment III wedge resections with laparoscopic PVL (LPVL).

Main Results:

• The laparoscopic first stage involved wedge resection and LPVL with a mean operative time of 189 minutes.
• Mean blood loss was minimal (22 cc), with no transfusions required.
• The procedure was feasible in patients with bilobar liver metastases.

Conclusions:

• The first stage of two-stage hepatectomy, including hepatic resection and PVL, is feasible using a laparoscopic approach.
• This minimally invasive strategy is suitable for patients with bilobar liver metastases requiring staged resection.
• The laparoscopic approach demonstrates low blood loss and avoids transfusions, suggesting favorable early outcomes.