Colorectal cancer is the third most common cancer in the United States. Roughly one half of patients with primary colorectal cancer will develop liver metastases. When feasible, the combination of hepatic resection and chemotherapy can achieve 5-year survival rates in the range of 50% to 58%. Patients with extensive bilateral hepatic disease are often deemed not to be operative candidates because complete curative resection may not be possible while maintaining an adequate future liver remnant. More recently, a two-stage approach has been advocated as a means to achieve complete surgical extirpation of all metastatic disease. The two-stage approach usually involves an initial partial resection followed by some time to allow interval hepatic hypertrophy. Often portal vein ligation or embolization is used to augment hepatic hypertrophy. At the second operation, complete removal of all remaining hepatic metastases is achieved. In well-selected patients, two-stage hepatectomy is feasible, safe, and efficacious, with reported 3-year survival rates ranging from 35% to 86% in patients with metastases that otherwise would have been considered unresectable.
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