gms | German Medical Science

Introduction: Colorectal carcinoma is one of the most frequent cancer entities worldwide. Despite improvement of therapeutic strategies metastatic disease is still associated with impaired overall survival. The only curative treatment option of liver metastases is surgical resection. In case of marginal resectable liver metastasis in situ split (ISS) of the liver is a possibility of individual surgical treatment.

Material and methods: Patients who underwent in situ split of the liver due to resection of colorectal cancer metastases in 2011 and 2012 were analyzed retrospectively regarding intra- and perioperative factors like dissection technique, central vein pressure, blood loss and postoperative outcome.

Results: Eight patients were included into the study, 4 males and 4 females with a median age of 54 years at the time of ISS operation (IQR 39 – 63.25 years). The median time interval between in situ split of the liver and following liver resection was 8 days (IQR 7.0 – 9.25 days). 6 patients were preoperatively classified ASA II and 2 ASA III. The mean estimated intraoperative blood loss on ISS and completion of liver resection was 760 ml and 400 ml, respectively. Dissection was performed with Cavitron Ultrasonic Surgical Aspirator (CUSA®) in four cases; Ligasure™ was used in three and crush clamp technique with linear stapler in one case. The median central vein pressure was 6.75 mmHg (IQR 5.5 – 10.625), during resection a median minimum of 2.5 mmHg (IQR 1.75 – 4.0) was reached. With a median follow up period of one year after in situ split operation, the median overall survival was 664 days.

Conclusion: In individual cases a two-stage procedure with in situ split of the liver followed by completion of liver resection can be an opportunity for surgical treatment of marginal resectable liver metastases. Due to modern dissection techniques and selective reduction of central vein pressure intraoperative blood loss can be minimized to further extent.