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Two-stage Hepatectomy — SCE Medical Oncology MCQ

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HardGI CancersTwo-stage HepatectomySCE Medical Oncology

A 60-year-old man with CRC liver metastases has an excellent response to FOLFOX. His surgeon is considering a two-stage hepatectomy. What does this involve?

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Correct answer: D — First-stage: resection of metastases in one lobe + portal vein ligation of the contralateral lobe

Two-stage hepatectomy is a strategy for extensive bilobar CRC liver metastases where single-stage resection would leave insufficient FLR. Stage 1: clear metastases from the FLR (usually left lobe) + right portal vein ligation/embolisation. During the 4-8 week interval, the cleared left lobe hypertrophies. Stage 2: right hepatectomy (removing the remaining metastases-bearing lobe). Approximately 70-80% of patients proceed to stage 2. An alternative is ALPPS (faster hypertrophy but higher morbidity). Five-year survival after complete two-stage resection is approximately 30-40%.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer