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World J Hepatol. Jun 27, 2019; 11(6): 513-521
Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.513
Outcomes of staged hepatectomies for liver malignancy
Naif A Albati, Ali A Korairi, Ibrahim Al Hasan, Helayel K Almodhaiberi, Abdullah A Algarni
Naif A Albati, Ali A Korairi, Ibrahim Al Hasan, Helayel K Almodhaiberi, Abdullah A Algarni, Hepatobiliary and Liver Transplant Unit, Department of General Surgery, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
Author contributions: Algarni AA, Al Hasan I and Almodhaiberi HK designed the study; Albati NA and Korairi AA collected, analyzed and interpreted the data, and drafted the article; Algarni AA designed the concept, critically revised the manuscript for important intellectual content, and gave the final approval of the version to be published.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Naif A Albati, MD, Surgeon, Hepatobiliary and Liver Transplant Unit, Department of General Surgery, Prince Sultan Military Medical City, Makkah Al Mukarramah Street 660-112, Riyadh 11159, Saudi Arabia. nalbati@psmmc.med.sa
Telephone: +966-56-3033330
Received: March 25, 2019
Peer-review started: March 26, 2019
First decision: May 21, 2019
Revised: May 27, 2019
Accepted: June 17, 2019
Article in press: June 18, 2019
Published online: June 27, 2019
Processing time: 94 Days and 20.8 Hours
Abstract

Liver malignancies are the fifth most common cause of death worldwide. Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival. However, only 20% of patients with metastatic liver lesions can be managed by curative liver resection. In most of the cases, hepatectomy is not feasible because of insufficient future liver remnant (FLR). Two-stage hepatectomy is advocated to achieve liver resection in a patient who is considered to not be a candidate for resection. Procedures of staged hepatectomy include conventional two-stage hepatectomy, portal vein embolization, and associating liver partition and portal vein ligation for a staged hepatectomy. Technical success is high for each of these procedures but variable between them. All the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage resection. Moreover, the overall survival and disease-free survival rates have improved significantly for patients who were otherwise considered nonresectable; yet, an increase in the morbidity and mortality rates has been observed. We suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary approach. An experienced surgeon is key to the success of those interventions.

Keywords: Staged hepatectomy; Portal vein embolization; Portal vein ligation; Colorectal liver metastasis; Hepatocellular carcinoma; Associated liver partition and portal vein ligation for staged hepatectomy

Core tip: Surgical intervention with curative intent is the treatment of choice for liver tumors. A variety of techniques have been established to increase the possibility for resectability. Two-staged hepatectomy, with its distinguishing beneficial procedures, is one of the techniques that have been proposed to overcome this clinical challenge. In spite of higher perioperative morbidity and mortality associated with this procedure, the overall survival and disease-free survival rates have increased significantly. Patient selection through consensus by a multidisciplinary board panel is the mainstay to successful performance of this procedure.