Extending the Limits of Resection for Colorectal Liver Metastases ENHANCED ONE STAGE SURGERY

Excerpt

Patients with multiple bilobar colorectal liver metastases (CLM) are the most complex to treat because a large parenchyma sacrifice is often required leading to the risk of postoperative liver failure. To prevent this risk, the two-stage hepatectomy (TSH) was proposed [1] and is now a standardized procedure adopted worldwide. However, the risk of drop-out between the two stages remains relevant, and for that, some alternatives have been advanced: the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure [2], which reduces the number of drop outs but is still associated with elevated postoperative mortality, and the ultrasound-guided one-stage hepatectomy (OSH) [3]. The latter, commonly adopted for superficial lesions (cherry-picking surgery), has been extended by the author to deep-located CLM, introducing the concept of enhanced-OSH (e-OSH) (Fig. 1) [3]. This approach assembles various parenchyma-sparing solutions developed in the years for presentations usually requiring major hepatectomies [4].

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