Two-step surgery for synchronous bilobar liver metastases from digestive endocrine tumors: a safe approach for radical resection.

Abstract

OBJECTIVE:

We describe the early and distant results of a 2-step surgical strategy that enables complete resection in selected patients with primary digestive endocrine tumors (DET) and synchronous bilobar liver metastases (LM).

BACKGROUND:

Frequent synchronous and bilobar liver involvement limits indications of surgery in LM from DET.

STUDY DESIGN:

From 1996 to 2004, of 41 patients with synchronous bilobar LM from DET, 23 (56%) were selected for 2-step surgery. The first step included resection of the primary tumor and limited (nonanatomic) resection of left LM (segments 1-4) associated with a right portal vein ligation. After 8 weeks, following hypertrophy of the cleared left liver, a right or extended right hepatectomy was planned.

RESULTS:

At the first step, all primary tumors (bowel = 12, distal pancreas = 10, rectal = 1) were resected and LM were resected in 20 patients (87%). One patient did not have second-step due to tumor progression. The second step (n = 19; 83%) was performed after a median interval of 8 weeks (range, 6-13) and a 54 +/- 21% mean left liver hypertrophy rate. Postoperatively, 4 (17%) and 4 (21%) patients developed nonlethal complications and the median hospital stay was 11 (range, 7-26) and 13 (range, 9-17) days after the first and the second step, respectively. The median number of resected LM was 4 (range, 1-9) and 7 (range, 4-17), respectively. With a median follow-up of 64 months (range, 6-122), of the 19 patients who had complete 2-step surgery, all except one are alive. The 2-, 5-, and 8-year Kaplan-Meier overall and disease-free survival rates were 94%, 94%, 79% and 85%, and 50% and 26%, respectively.

CONCLUSIONS:

This 2-step surgery approach enables complete resection with no mortality, acceptable morbidity, and good long-term survival in selected patients with synchronous bilobar LM from DET.

• Authors: Reza Kianmanesh, Alain Sauvanet, Olivia Hentic, Anne Couvelard, Philippe Lévy, Valérie Vilgrain, Philippe Ruszniewski, Jacques Belghiti
• Journal: Annals of surgery (Ann Surg) Vol. 247 Issue 4 Pg. 659-65 (Apr 2008) ISSN: 0003-4932 [Print] United States
• PMID: 18362629 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Digestive System Neoplasms (pathology, surgery)
• Endocrine Gland Neoplasms (pathology, surgery)
• Female
• Hepatectomy (methods)
• Humans
• Liver Neoplasms (secondary, surgery)
• Male
• Middle Aged
• Survival Analysis
• Treatment Outcome