Curative two staged hepatectomy for colorectal metastasis, 62y no comorbidiy presented with large rt hepatic flexure mass on colonoscopy, and biopsy showing moderately differentiated adenocarcinoma, ct staging showing multiple liver metastasis (5 at lt lobe s 2,3. And large one rt lobe that almost ocuppying s7,8,and par from s4a,5), otherwise no other metastasis to other organs,
1st operation (extended rt colectomy with local exicision of all left lobe metastasis,and ligation of rt main portal branch )
Then referred to oncology team and arranged for 6 cycles chemotherapy (downstaging and give chance to left lobe to compensate and regenerate) and referred back, new triphasic ct of the liver showed marked decrease in the size of rt lesion by about 50% and left lobe get sufficient volume that measure about 40%of total liver volume, so now the oncologist asked to proceed for another 6cycles chemotherapy 1st , or to proceed for extended rt hepatectomy and then take the rest of cycles after surgery???