Laparoscopic approach to a planned two-stage hepatectomy for bilobar colorectal liver metastases

Background: This report describes the technical aspects and outcomes of a laparoscopic approach in planned two-stage liver resections for patients with bilobar colorectal cancer (CRC) liver-only metastases. Methods: This is a retrospective review of our database examining consecutive patients who underwent an initial first-stage laparoscopic liver resection for CRC metastases, with a planned second-stage resection from 2007 to 2013. Results: Seven patients underwent an initial laparoscopic first stage with concurrent right portal vein ligation (RPVL) in two patients. Median operating time was 100 (60-170) min with a median blood loss of 100 (50-400) mL. Median length of stay was 3 (2-5) days. The remaining five patients required post-operative right portal vein embolization (RPVE). All patients had significant hypertrophy of the future liver remnant (FLR) (future liver remnant volume (FLRV) > 25%) and six patients subsequently had a successful open right hepatectomy with one attempted laparoscopically converted to open. Two patients had prolonged bile leaks after the second procedure. Three patients remained disease free, with median follow-up of 34 (13-80) months. One patient had disease progression following RPVE precluding performance of second stage. Conclusion: Laparoscopic first-stage resection of tumours in the left liver can be safely combined with RPVL/ RPVE to achieve adequate hypertrophy of the FLR, allowing subsequent right hepatectomy.