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ORIGINAL ARTICLE
Laparoscopic First-stage Approach in a Two-stage

Hepatectomy for Bilobar Colorectal Liver Metastases

1
3
Yuki Takahashi , Kuniya Tanaka 2 , Tetsuji Wakabayshi , Toshimitsu Shiozawa 4
AbstrAct
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.
Keywords: Colorectal cancer, Laparoscopic resection, Liver metastases, Two-stage hepatectomy.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1453

IntroductIon 1–4 General and Gastroenterological Surgery, Showa University
Two-stage hepatectomy has emerged as a valuable strategy for Fujigaoka Hospital, Yokohama, Kanagawa, Japan
curative treatment of patients with marginally resectable bilobar Corresponding Author: Kuniya Tanaka, General and
colorectal liver metastases that cannot be removed by a single Gastroenterological Surgery, Showa University Fujigaoka Hospital,
hepatectomy without unacceptable risk of liver failure. At present, Yokohama, Kanagawa, Japan, Phone: +81-45-971-1151, e-mail:
this procedure is performed routinely for patients with bilobar u1792ts235@med.showa-u.ac.jp
liver metastases from aggressive colorectal or neuroendocrine How to cite this article: Takahashi Y, Tanaka K, Wakabayshi T, et al.
cancers at many hepatobiliary centers worldwide. Two-stage Laparoscopic First-stage Approach in a Two-stage Hepatectomy for
hepatectomy has improved resectability rates by 10 to 50% Bilobar Colorectal Liver Metastases. World J Lap Surg 2021;14(2):90–94.
in unresectable or borderline-resectable patients, 1–4 but this Source of support: Nil

strategy risks considerable morbidity and high risk of disease Conflict of interest: None
progression after the first stage, leading to a reported drop-out
rate of 15 to 30%. 5
Ongoing experience with laparoscopic liver resection has
gradually expanded indications for laparoscopic surgery to MAterIAls And Methods
include major as well as minor hepatectomies. Although many
reported case series have shown favorable results after open two- Patients
stage hepatectomy, reports evaluating a laparoscopic approach A database including 64 patients with colorectal liver metastases
to two-stage hepatectomy have remained limited, impeding undergoing two-stage hepatectomy was reviewed. Among
discussion of a laparoscopic first stage in a two-stage hepatectomy. these patients, three had a laparoscopic first-stage hepatectomy.
Laparoscopic resection for the first stage could reduce morbidity Here, we report details comparing these three patients to the
and possibly simplify the second operation by limiting adhesions. 61 patients undergoing open two-stage hepatectomy. We
In fact, laparoscopy might allow one and possibly both stages to further reviewed previously reported clinical series involving
be performed with only minimal invasiveness. laparoscopic first stages in two-stage hepatectomy. The study
Here, we report a small series of three patients undergoing a protocol was approved by the ethics committee at our institutions
two-stage hepatectomy with a laparoscopic first-stage resection (IRB protocol approval numbers, B110707040 and F2020C25).
for colorectal liver metastases, providing some preliminary data Written informed consent was obtained from all patients involved
regarding feasibility and safety. in this study.

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