One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: A feasible and effective alternative to the 2-stage approach
Torzilli G et al. - Intraoperative ultrasonography (IOUS)-guided resection based on strict criteria allows a 1-stage operative treatment in selected patients with multiple bilobar colorectal liver metastases (CLM). Methods- Study explores the safety and effectiveness of 1-stage operative procedures in pts with multiple bilobar colorectal metastases, otherwise recommended for the 2-stage approach
- 29 pts with ≥4 bilobar CLM were selected from 100 consecutive pts
- Total number of preoperative CLM was 163
- Operative strategy was based on:
- Tumor-vessel relationships at IOUS and
- Findings at color Doppler IOUS
Results- No in-hospital mortality; tumor removal was feasible with 1-stage operative procedures in all but 3 pts who underwent laparotomy
- Overall morbidity rate was 23% (6/26); none of the pts required reoperation
- Major morbidity occurred in 1 patient (4%)
- Blood transfusions were administered in 4 pts (15%)
- After a mean f/u of 17 mo:
- 3 pts had died from systemic recurrence
- 12 pts were alive without disease, and
- 11 were alive with disease
- No local recurrences were observed at the resection margin
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