Staged liver resection for colorectal metastases: a valuable strategy or a waste of time?

BACKGROUND: The use of staged liver resections for colorectal metastases has been increasing in recent times. The aim of this study was to determine the practices and outcomes of those surgeons attending the Australia and New Zealand Hepatic, Pancreatic and Biliary Association (ANZHPBA) meeting in 2008 who perform staged resections. METHODS: A questionnaire was sent to all members of the ANZHPBA and the international faculty who were invited to attend the annual meeting held in Coolum, Queensland, Australia in October 2008. RESULTS: There were 30 responses from 7 centres across the UK, Germany and Australia. Twenty-eight patients completed treatment. The study population was predominantly male (n=20, 67%), with an average age of 59.4 years. All patients had bilobar disease. A right-sided first resection was planned in 39% of cases. Seventeen percent of patients underwent portal vein embolization prior to first resection. A second operation was performed at an average of 2.8 months from the first resection. Overall, 50% (n=14) of patients eventually achieved a complete (R0) staged procedure. Twelve complications after the first resection were seen in 32% patients (n=9). Twenty-three patients underwent a second liver resection. Twenty-five complications after the second resection were present in 57% (n=13). CONCLUSIONS: Two-stage liver resections are beneficial if both stages are completed and an R0 resection is achieved. While there is increased morbidity and mortality, we believe that staged liver resection for colorectal metastases is a valuable strategy in selected cases. (Hepatobiliary Pancreat Dis Int 2010; 9:600-604)