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One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: A feasible and effective alternative to the 2-stage approach
Surgery, 06/25/09

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