119 results on '"Two stage hepatectomy"'
Search Results
2. Optimal patient selection for successful two‐stage hepatectomy of bilateral colorectal liver metastases
- Author
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Marc-Antoine Allard, Hideo Baba, Katsunori Imai, and René Adam
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endocrine system ,medicine.medical_specialty ,RD1-811 ,endocrine system diseases ,Early Recurrence ,medicine.medical_treatment ,RC799-869 ,Review Article ,Disease ,Medicine ,Effective treatment ,Review Articles ,Selection (genetic algorithm) ,business.industry ,two‐stage hepatectomy ,Mortality rate ,Gastroenterology ,Diseases of the digestive system. Gastroenterology ,Surgery ,colorectal liver metastases ,Two stage hepatectomy ,Treatment strategy ,Hepatectomy ,business ,hormones, hormone substitutes, and hormone antagonists ,patient selection - Abstract
Two‐stage hepatectomy (TSH) is one of the specific surgical techniques that can expand the pool of resectable patients with initially unresectable colorectal liver metastases (CRLM). The indication of TSH for CRLM is only bilateral, multinodular disease, which cannot be resected by a single hepatectomy. TSH is nowadays considered an effective treatment for selected patients, with acceptable morbidity/mortality rates and promising long‐term outcomes. However, not all eligible patients can benefit from the TSH strategy. One of the most important issues is dropout from the strategy (failure to complete both of the two sequential procedures), because the survival of such patients is drastically worse compared with patients who can complete both stages. Another important issue is the early recurrence rate and subsequent poor survival even after completion of TSH. Thus, the selection of appropriate patients who can really benefit from the TSH strategy is crucial. This review discusses the optimal patient selection for TSH, which should be helpful for the development of treatment strategies for patients with extensive CRLM., Although two‐stage hepatectomy (TSH) for extensive colorectal liver metastases (CRLM) is nowadays considered an effective treatment for selected patients, with acceptable morbidity/mortality rates and promising long‐term outcomes, not all eligible patients can benefit from this strategy. In this review, we discuss the optimal patient selection for TSH, which should be helpful for the development of treatment strategies for patients with extensive CRLM.
- Published
- 2021
3. Revisión histórico - narrativa del ALPPS
- Author
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José Manuel Ramia Ángel, José R. Oliver Guillén, and Mario Serradilla Martín
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High morbidity ,medicine.medical_specialty ,business.industry ,Two stage hepatectomy ,medicine.medical_treatment ,General surgery ,medicine ,Surgery ,Observational study ,Hepatectomy ,Liver resections ,business - Abstract
Two-stage liver resections were described to increase the resectability of liver tumors in patients with insufficient future liver remnant. The ALPPS procedure, described in 2011, has represented a breakthrough in the field of hepato-pancreato-biliary surgery. This technique accelerates the hypertrophy of the future liver remnant and reduces the interval between the two surgeries compared with previous techniques. ALPPS has gained popularity rapidly, with more than 1200 patients included in the world registry. Recommendations about indications, patient selection and surgical standardization have been discussed twice in international expert meetings. Although ALPPS has proven to be superior in terms of resectability (80-100% versus 60-90% of twostage hepatectomy), its rapid implementation has been punished with high morbidity and mortality reaching up to 40% and 9%, respectively, in the published series. The current evidence on the possible benefits and disadvantages is mainly based on observational studies. We present a historical review, describing the different technical modifications that have been carried out since its description, with a rigorous review in terms of morbidity, mortality, and oncological outcomes.
- Published
- 2021
4. Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: A Multi-institutional Analysis
- Author
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Georgios A. Margonis, Thomas A. Aloia, Callisia N. Clarke, Susan Tsai, Timothy M. Pawlik, Harveshp Mogal, Michael I. D’Angelica, T. Clark Gamblin, Mariana I. Chavez, Daniel Eastwood, Cecilia G. Ethun, Shishir K. Maithel, Sepideh Gholami, Bradford J. Kim, and Kathleen K. Christians
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medicine.medical_specialty ,medicine.medical_treatment ,Article ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Surgical oncology ,medicine ,Hepatectomy ,Humans ,Infusion pump ,Stage (cooking) ,Retrospective Studies ,Chemotherapy ,business.industry ,Liver Neoplasms ,Surgery ,Survival Rate ,Treatment Outcome ,Artery infusion ,Oncology ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
BACKGROUND: Two-stage hepatectomy (TSH) is an important tool in the management of bilateral colorectal liver metastases (CRLM). This study sought to examine the presentation, management and outcomes of patients completing TSH in major hepato-biliary centers in the United States. METHODS: A retrospective review from 5 liver centers in the United States identified patients who completed a TSH procedure for bilateral CRLM. RESULTS: From December 2000 to March 2016, a total of 196 patients were identified. The majority of procedures were performed with an open technique (n = 194, 99.5%). The median number of tumors was 7 (range, 2–33). One-hundred twenty-eight (65.3%) patients underwent portal vein embolization. More patients received chemotherapy prior to the first stage than chemotherapy administration preceding the second stage (92% vs. 60%, p = 0.308). Median overall survival was 50 months with a median follow-up of 28 months (range, 2–143). Hepatic artery infusion chemotherapy was administered to 64 (32.7%) patients with similar overall survival (OS) to those managed without an infusion pump (p = 0.848). Postoperative morbidity following the second stage resection was 47.4%. Chemotherapy prior to the second stage did not demonstrate an increased complications rate (p = 0.202). Readmission following the second stage was 10.3% and was associated with a decrease in disease-free survival (p = 0.003). Overall survival was significantly decreased by positive resection margins and increased estimated blood loss (EBL) (p = 0.036 and p = 0.05, respectively). CONCLUSION: This is the largest TSH series in the U.S. and demonstrates evidence of safety and feasibility in the management of bilateral CRLM. Outcomes are influenced by margin status and operative EBL.
- Published
- 2021
5. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis
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Roberto Hernandez-Alejandro, Luis I. Ruffolo, Alejandro Serrablo, Orlando Jorge M Torres, Bergthor Björnsson, and Ruslan Alikhanov
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medicine.medical_specialty ,medicine.medical_treatment ,Portal vein ligation ,030230 surgery ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Ligation ,Portal Vein ,business.industry ,Liver Neoplasms ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,Treatment Outcome ,Liver ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Risk stratification ,Colorectal Neoplasms ,business - Abstract
Since first described, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has garnered boisterous praise and fervent criticism. Its rapid adoption and employment for a variety of indications resulted in high perioperative morbidity and mortality. However recent risk stratification, refinement of technique to reduce the impact of stage I and progression along the learning curve have resulted in improved outcomes. The first randomized trial comparing ALPPS to two stage hepatectomy (TSH) for colorectal liver metastases (CRLM) was recently published demonstrating comparable perioperative morbidity and mortality with improved resectability and survival following ALPPS. In this review, as ALPPS enters the thirteenth year since conception, the current status of this contentious two stage technique is presented and best practices for deployment in the treatment of CRLM is codified.
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- 2020
6. ALPPS - Beneficial or detrimental?
- Author
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Hauke Lang
- Subjects
medicine.medical_specialty ,Carcinoma, Hepatocellular ,business.industry ,Liver Neoplasms ,MEDLINE ,Surgery ,Cholangiocarcinoma ,Treatment Outcome ,Bile Duct Neoplasms ,Oncology ,Two stage hepatectomy ,medicine ,Hepatectomy ,Humans ,Colorectal Neoplasms ,business - Published
- 2020
7. ALPPS versus two-stage hepatectomy for colorectal liver metastases—–a comparative retrospective cohort study
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Gregory van der Kroft, Ulf P. Neumann, Georg Lurje, Samara Sharmeen, Pavel Strnad, Zoltan Czigany, Philipp Bruners, Jan Bednarsch, Peter Isfort, Tom Florian Ulmer, Surgery, and RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
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Male ,SURGERY ,medicine.medical_treatment ,CRLM ,030230 surgery ,chemotherapy ,INCREASE ,Muscle hypertrophy ,0302 clinical medicine ,Surgical oncology ,FAILURE ,Portal Vein ,TSH ,PARTITION ,Liver Neoplasms ,Middle Aged ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Embolization, Therapeutic ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Female ,Colorectal Neoplasms ,medicine.medical_specialty ,endocrine system ,STAGED HEPATECTOMY ,HEPATIC RESECTION ,lcsh:Surgery ,survival ,PORTAL-VEIN LIGATION ,lcsh:RC254-282 ,03 medical and health sciences ,medicine ,Hepatectomy ,Humans ,In patient ,Ligation ,Aged ,Retrospective Studies ,business.industry ,Research ,Retrospective cohort study ,Perioperative ,lcsh:RD1-811 ,Surgery ,HYPERTROPHY ,Two stage hepatectomy ,ALPPS ,business ,Oncological outcome - Abstract
Abstract Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/PVE) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery. The aim of this report is to compare the oncologic outcome and technical feasibility of ALPPS and TSH/PVE in the scenario of colorectal liver metastases (CRLM). Methods All consecutive patients who underwent either ALPPS or TSH/PVE for CRLM between 2011 and 2017 in one hepatobiliary center were analyzed and compared regarding perioperative and long-term oncologic outcome. Results A cohort of 58 patients who underwent ALPPS (n = 21) or TSH/PVE (n = 37) was analyzed. The median overall survival (OS) was 28 months and 34 months after ALPPS and TSH/PVE (p = 0.963), respectively. The median recurrence-free survival (RFS) was higher following ALPPS with 19 months than following TSH/PVE with 10 months, but marginally failed to achieve statistical significance (p = 0.05). There were no differences in morbidity and mortality after stages 1 and 2. Patients undergoing ALPPS due to insufficient hypertrophy after TSH/PVE (rescue-ALPPS) displayed similar oncologic outcome as patients treated by conventional ALPPS or TSH/PVE (p = 0.971). Conclusions ALPPS and TSH/PVE show excellent technical feasibility and comparable long-term oncologic outcome in CRLM. Rescue ALPPS appears to be a viable option for patients displaying insufficient hypertrophy after a TSH/PVE approach.
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- 2020
8. Editorial comment on: surgical outcomes of two-stage hepatectomy for colorectal liver metastasis: comparison to a benchmark procedure
- Author
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Zhongkai Wang and Brian K. P. Goh
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medicine.medical_specialty ,Viewpoint ,Two stage hepatectomy ,business.industry ,Benchmark (computing) ,medicine ,Radiology ,medicine.disease ,business ,Metastasis - Abstract
Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant. The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE, and to critically review the selection criteria for TSH-PVE.A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007-2017 was performed. Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy (RH) only.Twenty-nine patient underwent TSH, 25 of whom (86.2%) completed both stages. These patients demonstrated a major complication rate of 17%, and a 90-day mortality rate of 3.4%. Most complications (80%) were related to the colonic resection, and one patient developed liver failure. Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions. Ablative techniques were utilized in 76%. When compared to 35 patients who underwent sole RH, no significant difference was demonstrated in major complication rate (20%) or mortality (0%).TSH is a relatively safe procedure in selected patients. Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible. Factors such as number of lesions, comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.
- Published
- 2021
9. Possibility of repeat surgery for recurrence following two-stage hepatectomy for colorectal liver metastases: impact on patient outcome
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Francesco Ardito
- Subjects
medicine.medical_specialty ,two-stage hepatectomy ,business.industry ,Hepatic resection ,Settore MED/18 - CHIRURGIA GENERALE ,MEDLINE ,Treatment options ,Repeat Surgery ,030230 surgery ,Outcome (game theory) ,Surgery ,03 medical and health sciences ,Editorial ,colorectal liver metastases ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Perioperative chemotherapy ,Medicine ,repeat surgery ,In patient ,business - Abstract
Hepatic resection together with perioperative chemotherapy is currently the only treatment option that can offer a chance of long-term outcome in patients with colorectal liver metastases (CRLM), resulting in 5-year survival rates of 40%, and exceeding 50% in selected patients (1,2).
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- 2020
10. Two-Stage Hepatectomy with Portal Embolization to Treat Bilateral Hepatic Adenomas
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Fernando Fontes de Souza, Osvaldo Gonçalves da Silva Neto, Larissa Machado e Silva Gomide, Sergio Renato Pais-Costa, and Bruno Luis Oliveira Corrêa
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medicine.medical_specialty ,business.industry ,Two stage hepatectomy ,medicine.medical_treatment ,medicine ,General Medicine ,Embolization ,business ,Surgery - Published
- 2019
11. Two-stage hepatectomy for colorectal liver metastases: Pathologic response to preoperative chemotherapy is associated with second-stage completion and longer survival
- Author
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François Quenet, Lise Roca, Philippe Rouanet, Olivia Sgarbura, Lakhdar Khellaf, Emmanuel Deshayes, Frédéric Bibeau, Marie-Hélène Pissas, Hugo Gil, Hélène de Forges, S. Carrere, Marc Ychou, Institut du Cancer de Montpellier (ICM), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), and CCSD, Accord Elsevier
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Adult ,Male ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,030230 surgery ,Tumor response ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Pathologic Response ,Preoperative chemotherapy ,Stage (cooking) ,Aged ,Tumor Regression Grade ,Chemotherapy ,business.industry ,Liver Neoplasms ,Middle Aged ,3. Good health ,[SDV] Life Sciences [q-bio] ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Female ,Surgery ,Colorectal Neoplasms ,business - Abstract
International audience; BACKGROUND:Two-stage hepatectomy of bilobar colorectal liver metastases is widely used and shows encouraging survival results. However, the risk of dropout after the first stage remains high and is associated with poor survival. The objective of our study was to evaluate the factors associated with long-term survival based on the pathologic response to preoperative systemic chemotherapy in colorectal liver metastases patients who underwent two-stage hepatectomy.METHODS:The pathologic response to preoperative chemotherapy and its effect on second-stage completion and survival were retrospectively evaluated in 67 patients treated between 2003 and 2013.RESULTS:A total of 56 patients underwent two-stage hepatectomy for initially nonresectable colorectal liver metastases. Chemotherapy was combined with a biotherapy in 32 cases. The tumor regression grade, modified tumor regression grade, and Blazer grade were used to classify patients as responders (tumor regression grade and modified tumor regression grade 1-3, Blazer 0-1) or nonresponders (tumor regression grade and modified tumor regression grade 4-5, Blazer 2) after the first stage. Tumor response in the three classifications was associated with second-stage completion (tumor regression grade 1-3: OR = 4.01, 95% CI: 1.12-14.36, P = .033; modified tumor regression grade 1-3: OR = 3.8, 95% CI: 1.13-12.6, P = .03; Blazer 0-1: OR = 5.45, 95% CI: 1.66-17.85, P = .005). Triple chemotherapy was also associated with responders. The median overall survival of responders was significantly higher (Blazer 0-1: 42.9 months versus Blazer 2: 20.1 months, P = .018; tumor regression grade 1-3: 42.9 months versus tumor regression grade 4-5: 25.1 months, P = .04).CONCLUSION:A pathologic response to chemotherapy is associated with second-stage completion and longer survival. Further studies are needed to achieve the early identification of patients for whom the benefit of the second surgical stage is less straightforward.
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- 2019
12. Dealing with an insufficient future liver remnant: Portal vein embolization and two‐stage hepatectomy
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Heather A. Lillemoe, Yoshikuni Kawaguchi, and Jean Nicolas Vauthey
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Curative intent ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Liver resections ,Sequential treatment ,Resection ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Portal vein embolization ,medicine ,Preoperative chemotherapy ,030211 gastroenterology & hepatology ,Hepatectomy ,business - Abstract
Colorectal liver metastases (CLM) are not always resectable at the time of diagnosis. An insufficient future liver remnant is a factor excluding patients from curative intent resection. To deal with this issue, two-stage hepatectomy was introduced approximately 20 years ago. It is a sequential treatment strategy for bilateral CLM, which consists of preoperative chemotherapy, portal vein embolization, and planned first and second liver resections. This study reviews current evidence supporting use of two-stage hepatectomy.
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- 2019
13. Surgical outcomes of two-stage hepatectomy for colorectal liver metastasis: comparison to a benchmark procedure
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Almog Ben Yaacov, Aviram Nissan, Arie Ariche, Abbas Al-Kurd, Dan Aderka, and Eyal Mor
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medicine.medical_specialty ,business.industry ,Colorectal cancer ,Mortality rate ,medicine.medical_treatment ,030230 surgery ,medicine.disease ,Liver Insufficiency ,Surgery ,Metastasis ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,medicine ,Original Article ,Major complication ,Hepatectomy ,business - Abstract
Bakground: Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant. The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE, and to critically review the selection criteria for TSH-PVE. Methods: A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007–2017 was performed. Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy (RH) only. Results: Twenty-nine patient underwent TSH, 25 of whom (86.2%) completed both stages. These patients demonstrated a major complication rate of 17%, and a 90-day mortality rate of 3.4%. Most complications (80%) were related to the colonic resection, and one patient developed liver failure. Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions. Ablative techniques were utilized in 76%. When compared to 35 patients who underwent sole RH, no significant difference was demonstrated in major complication rate (20%) or mortality (0%). Conclusions: TSH is a relatively safe procedure in selected patients. Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible. Factors such as number of lesions, comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.
- Published
- 2019
14. Revisión histórico - narrativa del ALPPS
- Author
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Oliver Guillén, José R., Ramia Ángel, José M., and Serradilla Martín, Mario
- Subjects
Resección hepática ,Liver resection ,Split in-situ ,In-situ split ,Hepatectomía en dos tiempos ,Two stage hepatectomy ,ALPPS - Abstract
RESUMEN Las resecciones hepáticas en dos tiempos se desarrollaron para aumentar la resecabilidad de los tumo res hepáticos en pacientes con futuro remanente hepático insuficiente. El ALPPS, descripto en 2011, ha representado un gran avance en el mundo de la cirugía hepatobiliopancreática. Esta técnica acelera la hipertrofia del futuro remanente hepático y reduce el intervalo de tiempo entre las dos cirugías en comparación con las técnicas clásicas. El ALPPS ha ganado popularidad rápidamente, con más de 1200 pacientes incluidos en el registro mundial. Los comités internacionales de expertos se han reunido en dos ocasiones con el fin de emitir recomendaciones, principalmente sobre las indicaciones, selección de pacientes y estandarización de la técnica quirúrgica. Aunque ha demostrado ser superior en términos de resecabilidad (entre el 80-100% frente al 60-90% de la hepatectomía en dos tiempos), su rápida implementación ha sido penalizada con alta morbi mortalidad en las series publicadas, que llega a alcanzar el 40% y el 9%, respectivamente. Además, la evidencia actual sobre los posibles beneficios y desventajas se basa mayoritariamente en estudios observacionales. Presentamos una revisión histórica, describiendo las diferentes modificaciones técnicas que se han lle vado a cabo desde su inicio y realizando una revisión rigurosa en términos de morbilidad, mortalidad y resultados oncológicos. ABSTRACT Two-stage liver resections were described to increase the resectability of liver tumors in patients with insufficient future liver remnant. The ALPPS procedure, described in 2011, has represented a breakthrough in the field of hepato-pancreato-biliary surgery. This technique accelerates the hypertrophy of the future liver remnant and reduces the interval between the two surgeries compared with previous techniques. ALPPS has gained popularity rapidly, with more than 1200 patients included in the world registry. Recommendations about indications, patient selection and surgical standardization have been discussed twice in international expert meetings. Although ALPPS has proven to be superior in terms of resectability (80-100% versus 60-90% of two-stage hepatectomy), its rapid implementation has been punished with high morbidity and mortality reaching up to 40% and 9%, respectively, in the published series. The current evidence on the possible benefits and disadvantages is mainly based on observational studies. We present a historical review, describing the different technical modifications that have been carried out since its description, with a rigorous review in terms of morbidity, mortality, and oncological outcomes.
- Published
- 2021
15. From conventional two-stage hepatectomy to ALPPS: Fifteen years of experience in a hepatobiliary surgery unit
- Author
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Andrea Boscà Robledo, Eva Montalvá Orón, Alberto Alegre Delgado, Rafael López-Andújar, Javier Maupoey Ibáñez, Pablo Granero Castro, Alonso Camacho Ramírez, and Ana Hernando Sanz
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Posthepatectomy liver failure ,Complete resection ,Resection ,medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Ligation ,Retrospective Studies ,Two-stage hepatectomy ,Hepatology ,ALPPS, Colorectal liver metastases, Posthepatectomy liver failure, Two-stage hepatectomy ,Portal Vein ,business.industry ,Liver Neoplasms ,Gastroenterology ,Retrospective cohort study ,Perioperative ,Surgery ,Colorectal liver metastases ,Hepatobiliary surgery ,Treatment Outcome ,Two stage hepatectomy ,ALPPS ,Colorectal Neoplasms ,business - Abstract
Background: Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma removal. Conventional two-stage hepatectomy (TSH) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique are possible solutions to this problem. Colorectal liver metastases (CRLM) is the most frequent indication, and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these patients. Methods: A single-center retrospective study was designed to compare TSH with ALPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January 2020. ALPPS was performed from January 2012 onwards as the technique of choice. Long-term overall survival (OS) and disease-free survival (DFS) were evaluated as primary outcome in CRLM patients. Postoperative morbidity, mortality and liver growth in all patients were also evaluated. Results: A total of 38 staged hepatectomies were performed: 17 TSH and 21 ALPPS. Complete resection rate was 76.5% ( n = 13) in the TSH group and 85.7% ( n = 18) in the ALPPS group ( P = 0.426). Overall major morbidity (Clavien-Dindo >= 3a) (stage 1 + stage 2) was 41.2% ( n = 7) in TSH and 33.3% ( n = 7) in ALPPS patients ( P = 0.389), and perioperative 90-day mortalities were 11.8% ( n = 2) vs. 19.0% ( n = 4) in each group, respectively ( P = 0.654). Intention-to-treat OS rates at 1 and 5 years in CRLM patients for TSH ( n = 15) were 80% and 33%, and for ALPPS ( n = 17) 76% and 35%, respectively. DFS rates at 1 and 5 years were 36% and 27% in the TSH group vs. 33% and 27% in the ALPPS group, respectively. Conclusions: ALPPS is an effective alternative to TSH in bilateral affecting liver tumors, allowing higher resection rate, but patients must be carefully selected. In CRLM patients similar long-term OS and DFS can be achieved with both techniques. (c) 2021 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.
- Published
- 2021
16. Management of future liver remnant: strategies to promote hepatic hypertrophy
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Tatsunori Miyata, Hirohisa Okabe, Yuki Kitano, Hiromitsu Hayashi, Toru Beppu, Kensuke Yamamura, Shinichi Akahoshi, and Katsunori Imai
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medicine.medical_specialty ,Two stage hepatectomy ,business.industry ,medicine.medical_treatment ,Portal vein embolization ,Urology ,Medicine ,Hepatectomy ,business ,Muscle hypertrophy - Published
- 2021
17. Limitations in resectability of colorectal liver metastases 2020 - A systematic approach for clinicians and patients
- Author
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Cornelis Verhoef, Dirk J. Grünhagen, Peter Metrakos, Erik Schadde, and Lucyna Krzywon
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0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,Resection ,Remnant liver ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,medicine ,Hepatectomy ,Humans ,Patient factors ,business.industry ,General surgery ,Liver Neoplasms ,Cancer ,medicine.disease ,Prognosis ,Patient population ,030104 developmental biology ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,business ,Colorectal Neoplasms - Abstract
Colorectal liver metastases (CRLM) affect over 50 % of all patients with colorectal cancer, which is the second leading cause of cancer in the western world. Resection of CRLM may provide cure and improves survival over chemotherapy alone. However, resectability of CLRM has to be decided in multidisciplinary tumor boards and is based on oncological factors, technical factors and patient factors. The advances of chemotherapy lead to the abolition of contraindications to resection in favor of technical resectability, but somatic mutations and molecular subtyping may improve selection of patients for resection in the future. Technical factors center around anatomy of the lesions, volume of the remnant liver and quality of the liver parenchymal. Multiple strategies have been developed to overcome volume limitations and they are reviewed here. The least investigated topic is how to select the right patients among an elderly and frail patient population for the large variety of technical options specifically for bi-lobar CRLM to keep 90-day mortality as low as possible. The review is an overview over the current state-of-the art and a systematic guide to the topic of resectability of CRLM for both clinicians and patients.
- Published
- 2020
18. Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis
- Author
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Liang Zhang, Zhentao Yang, Shiyu Zhang, Wenchao Wang, and Shusen Zheng
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Portal vein ligation ,associating liver partitioning and portal vein ligation for staged hepatectomy ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,hepatectomy ,systematic review ,Medicine ,Stage (cooking) ,two-stage hepatectomy ,business.industry ,Mortality rate ,Perioperative ,Odds ratio ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,030104 developmental biology ,colorectal liver metastases ,Oncology ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Meta-analysis ,Hepatectomy ,business - Abstract
Background: Pushing the surgical limits for initially unresectable colorectal liver metastases (CRLM) are two approaches for sequential liver resection: two-stage hepatectomy (TSH) and associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS). However, the role of each treatment modality remains ill-defined. The present meta-analysis was designed to compare the safety, efficacy, and oncological benefits between ALPPS and TSH in the management of advanced CRLM.Methods: A systematic literature search was conducted from online databases through to February 2020. Single-arm synthesis and cumulative meta-analysis were performed.Results: Eight studies were included, providing a total of 409 subjects for analysis (ALPPS: N = 161; TSH: N = 248). The completions of the second stage of the hepatectomy [98 vs. 78%, odds ratio (OR) 5.75, p < 0.001] and R0 resection (66 vs. 37%; OR 4.68; p < 0.001) were more frequent in patients receiving ALPPS than in those receiving TSH, and the waiting interval was dramatically shortened in ALPPS (11.6 vs. 45.7 days, weighted mean difference = −35.3 days, p < 0.001). Nevertheless, the rate of minor complications was significantly higher in ALPPS (59 vs. 18%, OR 6.5, p < 0.001) than in TSH. The two treatments were similar in 90-day mortality (7 vs. 5%, p = 0.43), major complications (29 vs. 22%, p = 0.08), posthepatectomy liver failure (PHLF; 9 vs. 9%, p = 0.3), biliary leakage (11 vs. 14%, p = 0.86), length of hospital stay (27.95 vs. 26.88 days, p = 0.8), 1-year overall survival (79 vs. 84%, p = 0.61), 1-year recurrence (49 vs. 39%, p = 0.32), and 1-year disease-free survival (34 vs. 39%, p = 0.66). Cumulative meta-analyses indicated chronological stability for the pooled effect sizes of resection rate, 90-day mortality, major complications, and PHLF.Conclusions: Compared with TSH, ALPPS for advanced CRLM resulted in superior surgical efficacy with comparable perioperative mortality rate and short-term oncological outcomes, while this was at the cost of increased perioperative minor complications.
- Published
- 2020
19. Repeat hepatectomy for recurrent colorectal cancer liver metastases after two-stage hepatectomy-limitations and opportunities
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Jean Nicolas Vauthey and Hop S. Tran Cao
- Subjects
medicine.medical_specialty ,Surgical approach ,Text mining ,Two stage hepatectomy ,business.industry ,medicine.medical_treatment ,medicine ,Recurrent Colorectal Cancer ,Repeat hepatectomy ,Hepatectomy ,business ,Surgery ,Resection - Abstract
Whether resection of recurrent colorectal cancer liver metastases (CLMs) can be safely performed after prior hepatectomy, especially after two-stage hepatectomy (TSH), and to what extent this aggressive surgical approach may impact patient outcomes and prolong survival, are important issues to investigate.
- Published
- 2020
20. Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: A bi-institutional, propensity score-matched study
- Author
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Brice Gayet, Olivier Scatton, S Okumura, Claire Goumard, David Fuks, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut Mutualiste de Montsouris (IMM)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Organoplatinum Compounds ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Leucovorin ,Kaplan-Meier Estimate ,030230 surgery ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Propensity Score ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,Left lobe ,Extended right hepatectomy ,Liver Neoplasms ,Retrospective cohort study ,Length of Stay ,Middle Aged ,3. Good health ,Surgery ,Liver ,Two stage hepatectomy ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Propensity score matching ,Feasibility Studies ,Camptothecin ,Female ,Laparoscopy ,Fluorouracil ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms - Abstract
The safety and feasibility of laparoscopic, two-stage hepatectomy for bilobar colorectal liver metastases is poorly evaluated.We reviewed retrospectively 86 consecutive patients who underwent complete two-stage hepatectomy (left lobe clearance as the first stage and standard/extended right hepatectomy as the second stage) for bilobar colorectal liver metastases between 2007 and 2017 in 2 tertiary centers. Short- and long-term outcomes were compared between laparoscopic and open two-stage hepatectomy before and after propensity score matching.Laparoscopic two-stage hepatectomy was performed in 38 patients and open two-stage hepatectomy in 48. After propensity score matching, 25 laparoscopic and 25 open patients showed similar preoperative characteristics. For the first stage, a laparoscopic approach was associated with lesser hospital stays (4 vs 7.5 days; P.001). For the second stage, a laparoscopic approach was associated with less blood loss (250 vs 500 mL; P = .040), less postoperative complications (32% vs 60%; P = .047), lesser hospital stays (9 vs 16 days; P = .013), and earlier administration of chemotherapy (1.6 vs 2 months; P = .039). Overall survival, recurrence-free survival, and liver-recurrence-free survival were comparable between the groups (3-year overall survival: 80% vs 54%; P = .154; 2-year recurrence-free survival: 20% vs 18%; P = .200; 2-year liver-recurrence-free survival: 39% vs 33%; P = .269). Although both groups had comparable recurrence patterns, repeat hepatectomies for recurrence were performed more frequently in the laparoscopic two-stage hepatectomy group (56% vs 0%; P = .006).Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases is safe and feasible with favorable surgical and oncologic outcomes compared to open two-stage hepatectomy.
- Published
- 2019
21. ALPPS for Colorectal Cancer Liver Metastases—Short and Long-Term Results
- Author
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Kerollos Nashat Wanis, Roberto Hernandez-Alejandro, and Bao Tram Nghiem
- Subjects
medicine.medical_specialty ,business.industry ,Colorectal cancer ,Two stage hepatectomy ,medicine.medical_treatment ,General surgery ,medicine ,In patient ,Portal vein ligation ,Long term results ,Hepatectomy ,business ,medicine.disease - Abstract
This chapter reviews the history, indications, and outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Various operative techniques are described, considerations for management of patients during the interstage period are discussed, and current evidence on short- and long-term outcomes following ALPPS performed in patients with colorectal liver metastases is summarized. Specific recommendations regarding patient selection and operative technique are offered.
- Published
- 2019
22. Computed Tomography with 3d Reconstructions in Planning Two Stage Hepatectomy ALPPS for Alveococcosis of the Liver (Case Report)
- Author
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A. P. Dunaev, O. Grigor'eva, E. Naydenov, A. Bashkov, S. Voskanyan, Yu. Udalov, Zh. Sheyh, and D. A. Shikunov
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Nuclear Energy and Engineering ,medicine.diagnostic_test ,business.industry ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Medicine ,030211 gastroenterology & hepatology ,Computed tomography ,Radiology ,business - Abstract
Purpose: To provide case report of alveococcosis of the liver, when ALPPS procedure was planned based on diagnostic information and 3D reconstructions of computed tomography. Material and methods: Computed tomography with bolus intravenous administration of 100 ml of contrast media Ultravist-370 was performed on multislice computed tomography Aquilion 64 Toshiba. Results: The preoperative planning is the crucial part of treatment to minimize or exclude liver insufficiency after resection. The minimal volume of remnant of the liver should be more than 25–30 % for normal parenchyma and more than 40 % in case of chronic pathologic diffuse process in the liver for example steatosis or cirrhosis. If the estimated volume of remnant is not enough to perform resection, two staged hepatectomy should be planned. According to CT data, the parenchyma of segment S2 and most of parenchyma S3, which together constitute the so-called lateral sector of the liver, were preserved. It allowed to plan an extended right-sided resection. However, the volume of the future liver remnant was 410 ml – about 30 % of the functioning part of the liver which was considered insufficient in view of the presence of prolonged biliary hypertension and a decreasing density of the parenchyma. Vascular elements of the left lateral sector – left hepatic artery, left hepatic vein and inferior vena cava were intact, however, there was a possibility of involving the wall of the left portal vein, due to its prolonged contact with the surface of the parasitic lesion. Using the segmentation tool on radiology workstation, a 3D surface model of the liver was built, where the localization of the pathologic lesion and its relationship with the main vessels were visually demonstrated. After preoperative preparation, a decision was made to perform ALPPS procedure. At the first stage intraoperative the adhesion of the parasitic lesion with the left portal vein was confirmed, which required its resection and plastic. Also in addition to the usual volume of the operation, an atypical resection of the S3 segment and Roux-en-Y choledochojejunostomy were performed. On the 7th day after the 1st stage, a control CT scan was performed, at which an increase in the volume of the remnant to 630 ml (46 % of the preserved parenchyma of the liver) was recorded. The hepatic artery, portal and hepatic veins of the future liver remainder were enhanced homogenously; drainage was traced in the area of parenchyma dissection after the second, l stage of the operation, CT was performed in 15 days to exclude liquid accumulations in the abdominal cavity and to assess the condition of the remnant due to a moderate increasing of the level of direct bilirubin up to 98 μmol/l. No pathological changes in the abdominal cavity were revealed, only free pleural effusion was observed in the pleural cavities with partial atelectasis of the lower lobes of the lungs. After conservative therapy the liver insufficiency was resolved. On the 20th day after the operation, the patient was discharged. Conclusion: In the described clinical case, computed tomography with 3D reconstructions made possible to obtain complete diagnostic information that was necessary for the surgeon to assess the resectability of the pathological process and to plan the type of surgical intervention.
- Published
- 2018
23. Surgical Resection for Recurrence After Two-Stage Hepatectomy for Colorectal Liver Metastases Is Feasible, Is Safe, and Improves Survival
- Author
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Ching Wei D. Tzeng, E. Simoneau, Reza J. Mehran, Heather A. Lillemoe, Thomas A. Aloia, Georgios Karagkounis, Yi Qian Nancy You, Guillaume Passot, Yoshikuni Kawaguchi, Yun Shin Chun, and Jean Nicolas Vauthey
- Subjects
Male ,Reoperation ,Surgical resection ,medicine.medical_specialty ,Lung Neoplasms ,Multivariate analysis ,medicine.medical_treatment ,Article ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Recurrent disease ,medicine ,Hepatectomy ,Humans ,Pneumonectomy ,First Recurrence ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Hazard ratio ,Gastroenterology ,Middle Aged ,Surgery ,Survival Rate ,Genes, ras ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Mutation ,Cohort ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,Colorectal Neoplasms ,business - Abstract
BACKGROUND: Recurrence rates are high for patients who have undergone two-stage hepatectomy (TSH) for bilateral colorectal liver metastases, and there is no established treatment approach for recurrent disease. This study aimed to determine the feasibility, safety, and prognostic impact of surgical resection for recurrence after TSH and the prognostic role of RAS mutation in this cohort. METHODS: The study included 137 patients intended to undergo TSH for bilateral colorectal metastases during 2003–2016. Clinicopathologic factors were compared using univariate and multivariate analysis. RESULTS: One hundred eleven patients (81%) completed TSH. The median recurrence-free survival in these patients was 12 months. Of the 83 patients with subsequent recurrence, 31 (37%) underwent resection for recurrence, and 11 underwent multiple resections for recurrence. Forty-eight operations were performed for recurrence: 23 repeat hepatectomies, 14 pulmonary resections, 5 locoregional resections, and 6 concurrent resections in multiple organ sites. The median overall survival (OS) among patients with recurrence was 143 months for patients who underwent resection and 49 months for those who did not (P
- Published
- 2018
24. Comparative outcome analysis of two-stage hepatectomy with PVE (TSH/PVE) versus ALPPS for patients with colorectal liver metastases (CRLM)
- Author
-
Jan Bednarsch, F. Meister, Zoltan Czigany, M Binnsbösel, Tom Florian Ulmer, Georg Lurje, I. Amygdalos, Ulf Neumann, D Morales Santana, S Sharmeen, J. Böcker, and Wenzel Schöning
- Subjects
medicine.medical_specialty ,business.industry ,Two stage hepatectomy ,Internal medicine ,Gastroenterology ,medicine ,Outcome analysis ,business - Published
- 2018
25. Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers
- Author
-
Eric Vibert, D. Castaing, Matteo Cimino, Doaa Mansour, Guido Torzilli, Ren Adam, Matteo Donadon, Katsunori Imai, and Luca Viganò
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Surgical margin ,medicine.medical_treatment ,Left liver ,030230 surgery ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Survival analysis ,Aged ,business.industry ,Liver Neoplasms ,One stage ,Middle Aged ,Survival Analysis ,Hospitals ,Treatment Outcome ,Italy ,Liver ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Feasibility Studies ,Severe morbidity ,Female ,Surgery ,France ,Colorectal Neoplasms ,business - Abstract
Background: Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal metastases (CLM). As alternative, ultrasound-guided one-stage hepatectomy (E-OSH) has been proposed even for deep-located nodules to compare TSH and E-OSH. Methods: All consecutive TSH at the Paul Brousse Hospital and E-OSH at the Humanitas Research Hospital were considered. The inclusion criteria were ≥6 CLM, ≥3 CLM in the left liver, and ≥1 lesion with vascular contact. A total of 74 TSH and 35 E-OSH were compared. Results: The 2 groups had similar characteristics. Drop-out rate of TSH was 40.5%. In comparison with the cumulated hepatectomies of TSH, E-OSH had lower blood loss (500 vs. 1,100 mL, p = 0.009), overall morbidity (37.1 vs. 70.5%, p = 0.003), severe morbidity (14.3 vs. 36.4%, p = 0.04), and liver-specific morbidity (22.9 vs. 40.9%, p = 0.02). R0 resection rate was similar between groups. E-OSH and completed TSH had similar overall survival (5-year 38.2 vs. 31.8%), recurrence-free survival (3-year 17.6 vs. 17.7%), and recurrence sites. Conclusions: E-OSH is a safe alternative to TSH for multiple bilobar deep-located CLM. Whenever feasible, E-OSH should even be considered the preferred option because it has excellent safety and oncological outcomes equivalent to completed TSH, without the drop-out risk.
- Published
- 2018
26. Robotic two-stage hepatectomy: Right hemihepatectomy after segment 4B resection and right portal vein embolisation
- Author
-
L. Haentjens and M. D'Hondt
- Subjects
medicine.medical_specialty ,Hepatology ,Right portal vein ,Two stage hepatectomy ,business.industry ,Gastroenterology ,medicine ,Right hemihepatectomy ,business ,Resection ,Surgery - Published
- 2021
27. An Overview of the Current Management of Bilobar Colorectal Liver Metastases
- Author
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Samir Pathak, Graeme J. Poston, and Rebecca K L Griggs
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Review Article ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Current management ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,medicine ,Surgery ,business - Abstract
Bilobar colorectal liver metastases (BCRLM) present a challenging scenario for liver surgeons globally. The following article aims to provide an overview of the different strategies which may be utilised in order to successfully manage advanced BCRLM.
- Published
- 2017
28. The laparoscopic approach for two stage hepatectomy: A single center five year experience
- Author
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I. Parmentier, M. D'Hondt, C. De Meyere, and Emily Taillieu
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Two stage hepatectomy ,Gastroenterology ,medicine ,business ,Single Center ,Surgery - Published
- 2020
29. Auxiliary living donor liver transplantation combined with two-stage hepatectomy for unresectable colorectal liver metastases
- Author
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Falk Rauchfuss, Alfred Königsrainer, Ivan Capobianco, Silvio Nadalin, and Utz Settmacher
- Subjects
medicine.medical_specialty ,Orthotopic liver transplantation ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Living Donors ,Immunology and Allergy ,Hepatectomy ,Humans ,Survival rate ,Transplantation ,business.industry ,Portal Vein ,Patient Selection ,Liver Neoplasms ,Total Hepatectomy ,Surgery ,Liver Transplantation ,Survival Rate ,Treatment Outcome ,Two stage hepatectomy ,030211 gastroenterology & hepatology ,Living donor liver transplantation ,business ,Colorectal Neoplasms - Abstract
Purpose of review To review the role of liver transplantation for unresectable colorectal liver metastases (u-CRLM) and to describe the intial experience with auxiliary living donor liver transplantation combined with two-stage hepatectomy for u-CRLM (i.e. living donor RAPID). Recent findings Patients affected with u-CRLM have a poor prognosis with 5 years overall survival (OS) rate less than 10% under standard modern chemotherapy.There is an actual international consensus that liver transplantation for u-CRLM represents a viable option in highly selected patients with OS rate at 5 years up to 80% notwithstanding high recurrence rates. Due to the scarcity of whole liver graft from deceased donors, the RAPID procedure (i.e. resection and partial liver segment 2-3 transplantation from deceased donors with delayed total hepatectomy) has been introduced as possible alternative. The RAPID procedure represents the most actual and modern fusion of the two most challenging procedures of modern hepatobiliary and liver transplant surgery: that is auxiliary partial orthotopic liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy. Although the deceased donor-RAPID procedure may show promising results, the basic problem of scarcity of organs from deceased donors and mainly the lack of splittable organs still remains. Summary The living donor RAPID, based on transplantation of left lateral segments from living donor, may represent the way out to this problem. It is feasible and safe (for both donor and recipient), but characterized by a very challenging high-end transplantological procedure.
- Published
- 2019
30. Laparoscopic two stage hepatectomy: combined Glissonean approach of hepatic pedicles and dorsal approach of right and middle hepatic veins and vascular reconstruction
- Author
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Maria Teresa Albiol, Santiago López-Ben, and Laia Falgueras
- Subjects
Male ,medicine.medical_specialty ,Hepatic Veins ,Two stages ,Middle hepatic veins ,03 medical and health sciences ,0302 clinical medicine ,Vascular reconstruction ,medicine ,Dorsal approach ,Hepatectomy ,Humans ,Contraindication ,Aged ,Hepatology ,business.industry ,Liver Neoplasms ,Surgery ,Two stage hepatectomy ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Hepatic veins ,030211 gastroenterology & hepatology ,Laparoscopy ,business ,Colorectal Neoplasms ,Vascular Surgical Procedures - Abstract
Major vascular involvement often constitutes a contraindication to the laparoscopic approach. Lopez-Ben and colleagues described a purely laparoscopic surgical technique consisting of two stages, eight weeks apart, utilizing the caudal view and proximal approach for complete removal of colorectal liver metastases in close proximity to all three hepatic veins.
- Published
- 2019
31. Long-Term Outcome After Conventional Two-Stage Hepatectomy Versus Tourniquet-ALPPS in Colorectal Liver Metastases: A Propensity Score Matching Analysis
- Author
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Asunción López-Conesa, Pascual Parrilla, Roberto Brusadin, Álvaro Navarro-Barrios, Ricardo Robles-Campos, Victor Lopez-Lopez, José J. López-Espín, and Julio Arevalo-Perez
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Overall survival ,Hepatectomy ,Humans ,In patient ,Propensity Score ,Ligation ,Aged ,Retrospective Studies ,Tourniquet ,Chemotherapy ,business.industry ,Portal Vein ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,Tourniquets ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Propensity score matching ,Surgery ,Female ,business ,Colorectal Neoplasms - Abstract
To compare the overall survival (OS) and disease-free survival (DFS) of Tourniquet-ALPPS (T-ALPPS) and conventional two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CRLM). A retrospective study from a prospectively collected database was performed between October 2000 and July 2016. TSH was performed before September 2011, after which time T-ALPPS became the technique of choice. A propensity score matching (PSM) was performed based on a 1:1 ratio with consideration of the following variables: number and size of metastases, bilobar disease presence, and chemotherapy received. Thirty-four patients received T-ALPPS; 41 patients received TSH. After PSM, 21 patients remained in each group, with 100% resectability in the T-ALPPS group and 90.5% resectability in the TSH group. The median OS for TSH was 41 months; for T-ALPPS, the median OS was 36 months (P = 0.925). The median DFS was 16 months in the TSH group; the median DFS was 9 months in the T-ALPPS group (P = 0.930). The 1-, 3-, and 5-year OS for TSH was 81%, 66.7%, and 23.8% vs. 76.2%, 57.1%, and 22.9% for T-ALPPS, respectively. The 1-, 3-, and 5-year DFS for TSH was 66.7%, 9.5%, and 5% vs. 44.6%, 11.1%, and 11.1% for T-ALPPS, respectively. The volume increase with T-ALPPS was superior to that with TSH (68% vs. 39%; P = 0.018). There were no differences in morbidity and mortality after stages 1 and 2. T-ALPPS produces a similar outcome to TSH, indicating that it could be a safe and effective alternative for curative hepatectomy for all patients.
- Published
- 2019
32. Comment on 'ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis'
- Author
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Roberto Troisi, Mariano Cesare Giglio, Giglio, Mariano Cesare, Troisi, Roberto, and Trosi Roberto, Ivan
- Subjects
medicine.medical_specialty ,Patients ,Portal Vein ,business.industry ,medicine.medical_treatment ,Liver Neoplasms ,MEDLINE ,Portal vein ,medicine.disease ,Surgery ,Metastasis ,Two stage hepatectomy ,medicine ,Hepatectomy ,Humans ,In patient ,Colorectal Neoplasms ,business - Published
- 2019
33. A Comparative Retrospective Study of in Situ Split Plus Portal Vein Ligation (ISLT) versus Conventional Two-stage Hepatectomy for Cholangiocellular Carcinoma
- Author
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A. Krieg, S. Vaghiri, Dimitrios Prassas, L. Kasprowski, Nadja Lehwald-Tywuschik, S. Alaghmand, Alexander Rehders, L. Schimmöller, and Wolfram T. Knoefel
- Subjects
In situ ,medicine.medical_specialty ,Hepatology ,Cholangiocellular carcinoma ,Two stage hepatectomy ,business.industry ,Gastroenterology ,medicine ,Retrospective cohort study ,Portal vein ligation ,business ,Surgery - Published
- 2021
34. Tumor Progression Molecular Pathways after ALPPS and Conventional Two-stage Hepatectomy in Patients with Colorectal Liver Metastases
- Author
-
Á. Navarro Barrios, C.M. Martínez Cáceres, A. López Conesa, R. Robles Campos, A. Caballero Illanes, J. De la Peña Moral, V. López López, P. Gómez Valles, and Roberto Brusadin
- Subjects
Oncology ,medicine.medical_specialty ,Hepatology ,Tumor progression ,Two stage hepatectomy ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,In patient ,business - Published
- 2021
35. 108P Comparative analysis of two-stage hepatectomy and enhanced one-stage hepatectomy in the setting of bilobar colorectal liver metastases
- Author
-
E.A. Ashimov, V.E. Zagainov, N.M. Kiselev, and H.G. Torgomyan
- Subjects
medicine.medical_specialty ,Oncology ,business.industry ,Two stage hepatectomy ,medicine.medical_treatment ,Internal medicine ,Medicine ,One stage ,Hematology ,Hepatectomy ,business ,Gastroenterology - Published
- 2020
36. A Successful Case of Conversion of Unresectable Multiple Colorectal Liver Metastases by Intensive Chemotherapy and Two-stage Hepatectomy (ALPPS)
- Author
-
Shuichiro Matoba, Yudai Fukui, Hiroya Kuroyanagi, Junichi Shindoh, and Kenji Tomizawa
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Two stage hepatectomy ,business.industry ,030220 oncology & carcinogenesis ,General surgery ,medicine ,Intensive chemotherapy ,030230 surgery ,business - Published
- 2016
37. Failure to Achieve a 2-Stage Hepatectomy for Colorectal Liver Metastases
- Author
-
Katsunori Imai, Hideo Baba, René Adam, Marc Antoine Allard, Antonio Sa Cunha, Henri Bismuth, Denis Castaing, Daniel Cherqui, Carlos Castro Benitez, and Eric Vibert
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,Weakness ,endocrine system diseases ,medicine.medical_treatment ,Gastroenterology ,Treatment failure ,Risk Factors ,Internal medicine ,Hepatectomy ,Humans ,Medicine ,Treatment Failure ,Stage (cooking) ,Survival rate ,Aged ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Middle Aged ,Prognosis ,Surgery ,Survival Rate ,Two stage hepatectomy ,Female ,France ,medicine.symptom ,Colorectal Neoplasms ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
The aim of the study was to identify predictive factors of failure of 2-stage hepatectomy (TSH) for the selection of patients with extensive bilobar colorectal liver metastases (CRLM), who are candidates for TSH.The main weakness of TSH is the risk of failure to complete both the sequential procedures.Between 2000 and 2012, from a total cohort of 845 patients resected for CRLM, 125 patients (14.8%) with extensive CRLM were planned for TSH. All factors related to the failure of TSH were analyzed, and a predictive model was built utilizing the independent predictive factors of failure.Forty-four patients (35.2%) could not proceed to the second stage, and their overall survival (OS) was significantly worse than that of those who completed the TSH (5-year OS: 0% vs 44.2%; P 0.0001). Multivariate analysis revealed that carcinoembryonic antigen30 ng/mL [relative risk (RR) 2.73, P = 0.03], tumor size40 mm (RR 2.89, P = 0.04), chemotherapy cycles12 (RR 3.46, P = 0.01), and tumor progression during first-line chemotherapy (RR 6.56, P = 0.01) were independent predictive factors of failure. For patients not presenting any factors, the probability of failure was 10.5%, with a 5-year OS rate of 41.9%. The addition of each subsequent factor increased the risk to 43.5%, 72.7%, 88.5%, and 95.5%, and decreased the 5-year OS to 38.8%, 29.2%, 0%, and 0%, respectively, for 1, 2, 3, and 4 factors.TSH should not be recommended in patients with more than 2 risk factors. Avoidance of these factors significantly reduces the risk of failure and is crucial for long-term survival.
- Published
- 2015
38. ALPPS and conventional two stage hepatectomy in intrahepatic cholangiocarcinoma
- Author
-
Joerg Boecker, Ulf P. Neumann, D Morales Santana, Jan Bednarsch, F. Meister, Zoltan Czigany, I. Amygdalos, and Georg Lurje
- Subjects
medicine.medical_specialty ,Hepatology ,Two stage hepatectomy ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,business ,Intrahepatic Cholangiocarcinoma - Published
- 2020
39. Two-Stage Hepatectomy and ALPPS for Advanced Bilateral Liver Metastases: a Tailored Approach Balancing Risk and Outcome
- Author
-
Florian Jungmann, Michael Kloth, J. Baumgart, Jens Mittler, Stefan Heinrich, Fabian Bartsch, and Hauke Lang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tailored approach ,medicine.medical_treatment ,030230 surgery ,Liver resections ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Hepatectomy ,Humans ,In patient ,Stage (cooking) ,Ligation ,Aged ,business.industry ,Portal Vein ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Cohort ,Female ,business ,Complication ,Colorectal Neoplasms - Abstract
Two-stage hepatectomy (TSH) with or without portal vein ligation (PVL) or portal vein embolization (PVE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) are surgical strategies in the treatment of advanced colorectal liver metastases (CRLM). The role of each strategy is yet ill defined. The aim of this analysis is to share our center experience with conventional TSH with or without PVL/PVE and ALPPS in patients with advanced bilateral CRLM. Data were extracted from a prospectively collected institutional database. Complication rates according to the Dindo-Clavien classification, overall and recurrence-free survival data were analyzed. Between 2008 and 2017, 790 liver resections were performed in 611 patients with CRLM. Out of 320 patients with bilateral disease, TSH (as right or extended right hepatectomy) with or without PVL/PVE was performed in 50 patients and ALPPS in 8. Stage 2 was completed in 36 (72%) out of 50 TSH/PVL/PVE and in all ALPPS patients (100%). Median follow-up was 15.8 months (0.9 to 111.9 months). On an intention-to-treat basis, the median overall survival was 26.7 (21.8–35.1 range) months after TSH/PVL/PVE and 36.2 months (11.3–61.2 range) after ALPPS (p = 0.809). In the TSH/PVL/PVE cohort, the median overall survival was 29.9 (19.0–40.3) months in patients who completed stage 2 compared to 13.8 months in patients who did not (p
- Published
- 2018
40. Response to 'ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases'
- Author
-
Bård I. Røsok, Nicolai A. Schultz, Anna Lindhoff Larsson, Bergthor Björnsson, Bjørn Atle Bjørnbeth, Per Sandström, Magnus Rizell, Bengt Isaksson, Gert Lindell, Peter Nørgaard Larsen, and Ernesto Sparrelid
- Subjects
medicine.medical_specialty ,business.industry ,Portal Vein ,medicine.medical_treatment ,Liver Neoplasms ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Medicine ,Hepatectomy ,Humans ,030211 gastroenterology & hepatology ,In patient ,business ,Colorectal Neoplasms - Abstract
Response to "ALPPS Versus Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastases"
- Published
- 2018
41. Comment on Letter to the Editor Regarding 'ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis: When Innovation is Not Enough'
- Author
-
Thomas A. Aloia, Eduardo A. Vega, Ching Wei D. Tzeng, Bruno C. Odisio, Jean Nicolas Vauthey, Yun Shin Chun, and E. Simoneau
- Subjects
medicine.medical_specialty ,Letter to the editor ,business.industry ,Portal Vein ,General surgery ,medicine.medical_treatment ,Liver Neoplasms ,Portal vein ,MEDLINE ,030230 surgery ,medicine.disease ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,medicine ,Hepatectomy ,Humans ,Surgery ,In patient ,business ,Colorectal Neoplasms - Published
- 2018
42. Fast-Track Two-Stage Hepatectomy Using a Hybrid Interventional Radiology/Operating Suite as Alternative Option to Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy Procedure
- Author
-
Bruno C. Odisio, A. Alex Holmes, E. Simoneau, Claudius Conrad, and Jean Nicolas Vauthey
- Subjects
Adult ,medicine.medical_specialty ,Operating Rooms ,Organoplatinum Compounds ,medicine.medical_treatment ,Leucovorin ,Portal vein ligation ,Radiography, Interventional ,03 medical and health sciences ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Hepatectomy ,Humans ,Embolization ,Ligation ,Colectomy ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Portal Vein ,Liver Neoplasms ,Interventional radiology ,Partition (database) ,Embolization, Therapeutic ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiology ,Fluorouracil ,Fast track ,business ,Colorectal Neoplasms - Published
- 2018
43. Two-Stage Approach to Liver Resection
- Author
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Roberto Hernandez-Alejandro and Kerollos Nashat Wanis
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Portal vein ,Portal vein ligation ,Resection ,Muscle hypertrophy ,Surgery ,Two stage hepatectomy ,Occlusion ,medicine ,Stage (cooking) ,Hepatectomy ,business - Abstract
This chapter reviews the history, indications, and outcomes of two-stage hepatectomy, including both conventional two-stage resection and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The underlying mechanisms of liver hypertrophy as they relate to two-stage resection and portal vein occlusion are explored.
- Published
- 2018
44. A systematic review and meta-analysis of ALPPS versus two-stage hepatectomy (TSH)
- Author
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X. Bai, T. Liang, Tao Ma, and Yinan Shen
- Subjects
Oncology ,medicine.medical_specialty ,Hepatology ,Two stage hepatectomy ,business.industry ,Meta-analysis ,Internal medicine ,medicine ,Gastroenterology ,business - Published
- 2019
45. Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systematic review and meta-analysis
- Author
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Ruiyun Xu, Zheng Zhou, Chuzhi Pan, Yuesi Zhong, Nan Lin, Boxuan Zhou, and Mingxing Xu
- Subjects
medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,lcsh:Surgery ,Urology ,Portal vein ligation ,030230 surgery ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Surgical oncology ,medicine ,Hepatectomy ,Humans ,Ligation ,Two-stage hepatectomy ,business.industry ,Portal Vein ,Research ,Patient Selection ,Liver Neoplasms ,lcsh:RD1-811 ,Odds ratio ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Prognosis ,Liver regeneration ,Liver Regeneration ,Meta-analysis ,Treatment Outcome ,Oncology ,Liver ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Surgery ,ALPPS ,business - Abstract
Background It is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities. Methods Relevant studies were identified by searching the selected databases up to September 2017. Then, a meta-analysis of regeneration efficiency, complication rate, R0 resection ratio, and short-term outcomes was performed. Results Ten studies, comprising 719 patients, were included. The overall analysis showed that ALPPS was associated with a larger hyperplastic volume and a shorter time interval (P
- Published
- 2017
46. Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases
- Author
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Maximiliano Gelli, Takeo Nomi, Brice Gayet, Vimalraj Velayutham, David Fuks, Satoshi Ogiso, Claudius Conrad, and C. Louvet
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Disease-Free Survival ,Occlusion ,medicine ,Hepatectomy ,Humans ,Preoperative chemotherapy ,Laparoscopy ,Survival rate ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,Surgery ,Survival Rate ,Treatment Outcome ,Two stage hepatectomy ,Female ,France ,Colorectal Neoplasms ,business - Abstract
Background Despite the gradual diffusion of laparoscopic liver resection, the feasibility and results of laparoscopic two-stage hepatectomy (TSH) for bilobar colorectal liver metastases (CRLM) have not been described frequently. This study aimed to evaluate the feasibility, safety and oncological outcomes of laparoscopic TSH for bilobar CRLM. Methods All patients eligible for laparoscopic TSH among those treated for bilobar CRLM from 2000 to 2013 were included. Demographics, tumour characteristics, surgical procedures, and short- and long-term outcomes were analysed. Results Laparoscopic TSH was planned in 34 patients with bilobar CRLM, representing 17·2 per cent of all 198 patients treated for bilobar CRLM. Thirty patients received preoperative chemotherapy, and 20 had portal vein occlusion to increase the volume of the remnant liver. Laparoscopic resection of the primary colorectal tumour was integrated within the first-stage hepatectomy in 11 patients. After a median interval of 3·1 months, 26 patients subsequently had a successful laparoscopic second-stage hepatectomy, including 18 laparoscopic right or extended right hepatectomies. The mortality rate for both stages was 3 per cent (1 of 34), and the overall morbidity rate for the first and second stages was 50 per cent (17 of 34) and 54 per cent (14 of 26) respectively. Mean length of hospital stay was 6·1 and 9·0 days respectively. With a median follow-up of 37·8 (range 6–129) months, 3- and 5-year overall survival rates in patients who completed TSH were 78 and 41 per cent respectively. The 3- and 5-year disease-free survival rates were 26 and 13 per cent respectively. Conclusion Laparoscopic TSH for bilobar CRLM is safe and does not jeopardize long-term outcomes in selected patients.
- Published
- 2015
47. Extending the Limits of Resection for Colorectal Liver Metastases ENHANCED ONE STAGE SURGERY
- Author
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Matteo Cimino and Guido Torzilli
- Subjects
medicine.medical_specialty ,One stage surgery ,business.industry ,General surgery ,Gastroenterology ,030230 surgery ,Resection ,Surgery ,Intraoperative ultrasound ,03 medical and health sciences ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,medicine ,business - Published
- 2016
48. Assessment and optimization of liver volume before major hepatic resection: Current guidelines and a narrative review
- Author
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Syed M. Atiq, Mohammad A. Ansari, Sandra Garcia-Aroz, Adeel S. Khan, M.B. Majella Doyle, William C. Chapman, Kathryn J. Fowler, and Michael Senter-Zapata
- Subjects
Male ,medicine.medical_specialty ,Hepatic resection ,medicine.medical_treatment ,Liver volume ,Portal vein ligation ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Preoperative Care ,medicine ,Hepatectomy ,Humans ,Ligation ,business.industry ,Portal Vein ,General Medicine ,Embolization, Therapeutic ,Surgery ,Liver Regeneration ,Treatment Outcome ,Liver ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,Portal vein embolization ,Practice Guidelines as Topic ,Narrative review ,Female ,business ,Vascular Surgical Procedures ,Liver Failure - Abstract
Post hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality after major liver resection. Although the etiology of PHLF is multifactorial, an inadequate functional liver remnant (FLR) is felt to be the most important modifiable predictor of PHLF. Pre-operative evaluation of FLR function and volume is of paramount importance before proceeding with any major liver resection. Patients with inadequate or borderline FLR volume must be considered for volume optimization strategies such as portal vein embolization (PVE), two stage hepatectomy with portal vein ligation (PVL), Yttrium-90 radioembolization, and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This paper provides an overview of assessing FLR volume and function, and discusses indications and outcomes of commonly used volume optimization strategies.
- Published
- 2017
49. Monosegment ALPPS hepatectomy preserving segment 4 for colorectal liver metastasis: literature review and our experience
- Author
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Irfan Ahmed, Jim Phillips, Francesco Giovinazzo, Bassam Alkari, Mohammad Habib, Jack Straiton, Giulia Turri, and Fiammetta Soggiu
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Liver volume ,Portal vein ligation ,Case Report ,030230 surgery ,Surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,colorectal liver metastases ,Associating Liver Partition and Portal Vein ligation for Staged hepatectomy (ALPPS) ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,liver resection ,medicine ,Overall survival ,Long term outcomes ,Stage (cooking) ,Hepatectomy ,business - Abstract
Monosegment 4±1 Associating Liver Partition and Portal Vein ligation for Staged hepatectomy (ALPPS) for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy, triggering a rapid and significant increase in future liver remnant (FLR) with promising oncological outcomes. We report two cases of segment 4+1 monosegment ALPPS for multiple colorectal liver metastases performed at our institution. In the literature, seven similar cases have been reported. Short and long term outcomes of our two patients were reported along with a review of data from the literature. Our patients showed a FLR increase from 13% to 37% and from 14% to 41% of total liver volume, respectively. This was compared to a median growth from 19% at baseline to 34% before stage 2, in the literature. After 20 and 27 months since resection both patients are alive and disease-free. In the literature, median overall survival and disease free survival were 13 months (range, 5-24 months) and 5 months (range, 3-23 months), respectively. Segment 4±1 ALPPS is associated with promising oncological outcomes and a significant FLR growth. It may be safely performed in selected patients as a salvage procedure, reducing the risk of the dropout of two-stage hepatectomy.
- Published
- 2017
50. Laparoscopic approach to a planned two-stage hepatectomy for bilobar colorectal liver metastases
- Author
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Adrian Kah Heng Chiow, Daniel J. Kilburn, Nicholas O'Rourke, Nicholas Kienzle, Joel Lewin, David Cavallucci, and Richard A. Bryant
- Subjects
medicine.medical_specialty ,Colorectal cancer ,business.industry ,medicine.medical_treatment ,General Medicine ,030230 surgery ,medicine.disease ,Surgery ,Muscle hypertrophy ,03 medical and health sciences ,0302 clinical medicine ,Two stage hepatectomy ,030220 oncology & carcinogenesis ,medicine ,Operating time ,Embolization ,Hepatectomy ,Stage (cooking) ,Ligation ,business - Abstract
Background This report describes the technical aspects and outcomes of a laparoscopic approach in planned two-stage liver resections for patients with bilobar colorectal cancer (CRC) liver-only metastases. Methods This is a retrospective review of our database examining consecutive patients who underwent an initial first-stage laparoscopic liver resection for CRC metastases, with a planned second-stage resection from 2007 to 2013. Results Seven patients underwent an initial laparoscopic first stage with concurrent right portal vein ligation (RPVL) in two patients. Median operating time was 100 (60–170) min with a median blood loss of 100 (50–400) mL. Median length of stay was 3 (2–5) days. The remaining five patients required post-operative right portal vein embolization (RPVE). All patients had significant hypertrophy of the future liver remnant (FLR) (future liver remnant volume (FLRV) >25%) and six patients subsequently had a successful open right hepatectomy with one attempted laparoscopically converted to open. Two patients had prolonged bile leaks after the second procedure. Three patients remained disease free, with median follow-up of 34 (13–80) months. One patient had disease progression following RPVE precluding performance of second stage. Conclusion Laparoscopic first-stage resection of tumours in the left liver can be safely combined with RPVL/RPVE to achieve adequate hypertrophy of the FLR, allowing subsequent right hepatectomy.
- Published
- 2014
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