Multistage liver resections for colorectal liver metastases. The Paul Brousse attitude

Hepatic resection is currently the only form of treatment that offers a chance of long-term survival, with rates ranging from 25 % to 39 %. However, a curative operation can be performed in only 10 % of patients with colorectal metastases to the liver. Our policy is to increase the number of patients that can benefit from fiver resection. Liver metastases can be considered as irresectable mainly in three different situations (sometimes associated): (I) large and/or poorly located tumors; (II) bilateral tumors in both liver lobes; (III) tumors technically resectable, but not operable because the liver remnant is too small, which is associated with a prohibitive risk of postoperative severe liver failure. The aim of this paper is to report the strategies we use in our center to achieve curative resection in these three schematic situations despite initial contraindications.