Two-stage hepatectomy for colorectal liver metastases in elderly adults

Abstract

Two-stage hepatectomy is a surgical strategy developed for cases of bilobar multinodular liver metastases. It is performed when all lesions cannot be removed in a single procedure due to a too small remnant liver volume. The main principle in this approach is a consecutive resection in two stages. It relies on the liver regeneration between the two interventions, allowing the second hepatectomy to be performed with a lower risk of complications. Subjects are patients with colorectal cancer liver metastases who undergo surgery at the surgical departments of Military Medical Academy of Plovdiv and Eurohospital of Plovdiv. For the period 2009-2013, 96 radical resections (58 metachronous and 38 synchronous). Of them, 58 are patients over 65 years of age. We performed 7 two-stage hepatectomies, 4 of these patients are aged over 65 years. Blood loss and blood transfusion were without significant differences between these two age groups. Complications rate in the postoperative period and the length of hospital stay were comparable, despite the higher level of comorbidity in the group aged over 65 years. Two-stage liver resections are a good opportunity for a small group of patients with bilobar metastases. The indications for this procedure can be successfully applied for elderly patients with appropriate perioperative management concerning the high co-morbidity in this group.