Regeneration After Two-Stage Hepatectomy vs Repeat Resection for Colorectal Metastasis Recurrence

Tanaka, Kuniya; Shimada, Hiroshi; Matsuo, Keitaro; Ueda, Mitsuharu; Endo, Itaru; Togo, Shinji

doi:10.1007/s11605-007-0221-0

Cited by 22 publications

(19 citation statements)

References 30 publications

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“…First, the drop-out rate of TSH was about 40%. These data are slightly higher than those reported in the literature [5, 10, 15, 36-39], but probably reflect the advanced liver involvement of the study population and the high incidence of concomitant extrahepatic disease. Some studies recently analyzed the predictors of drop-out between both the stages of TSH [40, 41].…”

Section: Discussioncontrasting

confidence: 73%

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

et al. 2018

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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.

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Section: Discussioncontrasting

confidence: 73%

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

et al. 2018

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“…Für Patienten, deren Leberrestvolumen nach Leberresektion als zu gering eingeschätzt wird, kön-nen verschiedene Strategien eingesetzt werden, die eine ausreichende Restleberfunktion (-und größe) ermöglichen. Verfahren wie portalvenöse Embolisation zur Hypertrophieinduktion des kontralateralen Leberlappens, 2-zeitige Leberresektion (mit und ohne systemische Therapiekomponente im Intervall) sowie neoadjuvante ("downsizing") Therapiekonzepte (besonders bei kolorektalen Lebermetasten) können einen Teil der als primär irresektabel eingestuften Patienten in einen resektablen Zustand überführen [6][7][8][9][10][11][12]. Ein neues, innovatives Konzept stellt die Kombination von rechtsseitiger Pfortaderligatur mit Parenchymdissektion entlang der geplanten Resektionslinie sowie 2-zeitiger Komplettierungsoperation dar [13].…”

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„In-situ-Split“- (ISS) Leberresektion: Neue Aspekte zu Technik und Indikation

Lang

Loss

2013

Zentralbl Chir

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The combination of right portal vein ligation with complete parenchyma dissection ("in-situ split", ISS) for rapid hypertrophy induction of the left-lateral liver lobe is a novel strategy to convert primarily irresectable liver tumours into a resectable stage. Available data so far show a 60-80 % growth induction of the remnant liver within 7(- 9) days. Certainly, a novel concept that comprises two operations within a very short time period raises questions. Based on the very few literature reports that have been published so far, as well as our own experience, we here discuss technical issues such as the use of a plastic sheet on the resection margin, the possibility of laparoscopic dissection and the timing of the second operation. Moreover, aspects of the preoperative diagnostic work-up that is necessary are assessed. Finally, open questions, e.g., concerning the influence of preoperative chemotherapy and the use of ISS in patients with cirrhosis are evaluated. In summary, the assessment of chances and risks of this novel concept with regard to indication and technical issues helps to provide the potentially curative option of the "in-situ split" procedure to more patients with marginal or even irresectable liver tumours.

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“…However, the embolization of segment IV branch requires optimal access, may frequently be incomplete and is not available in many centers. In some patients sufficient hypertrophy of the future liver remnant is not always achieved and there is still concern about the potential for simultaneous tumor progression after portal vein embolization during the period prior to resection 4,7,13,18 . In ALPPS approach, the portal vein ligation associated with in situ splitting is able to induce enormously accelerated hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

Ligadura da veia porta associada à bipartição do fígado para hepatectomia em dois estágios (ALPPS): experiência brasileira

Torres

Fernandes²,

Oliveira

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background -Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. To induce rapid and significant hepatic hypertrophy, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients which tumor is previously considered unresectable. Aim -To present the Brazilian experience with ALPPS approach. Method -Were analyzed 39 patients who underwent hepatic resection using ALPPS in nine hospitals. The procedure was performed in two steps. The first operation was portal vein ligation and in situ splitting. In the second operation the right hepatic artery, right bile duct and the right hepatic vein were isolated and ligated. The extended right lobe was removed. There were 22 male (56.4%) and 17 female (43.6%). At the time of the first operation, the median age was 57.3 years (range: 20-83 years). Results -The most common indication was liver metastasis in 32 patients (82.0%), followed by cholangiocarcinoma in three (7.7%). Two patients died (5.2%) during this period and did not undergo the second operation. The mean interval between the first and the second operation was 14.1 days (range: 5-30 days). The volume of the left lateral segment of the liver increased 83% (range 47-211.9%). Significant morbidity after ALPPS was seen in 23 patients (59.0%). The mortality rate was 12.8% (five patients). Conclusion -The ALPPS approach can enable resection in patients with lesions previously considered unresectable. It induces rapid liver hypertrophy avoiding liver failure in most patients. However still has high morbidity and mortality.RESUMO -Racional -Insuficiência hepática pós-operatória devido à remanescente hepático pequeno tem sido complicação temida em pacientes que são submetidos à ressecção hepática extensa. A ligadura da veia porta associada à bipartição do fígado para hepatectomia em dois estágios (ALPPS) foi desenvolvida recentemente com a finalidade de induzir rápida e significante regeneração do fígado para pacientes em que o tumor é previamente considerado irressecável. Objetivo -Apresentar a experiência brasileira com o ALPPS. Método -Foram analisados 39 pacientes submetidos ao procedimento ALPPS em nove hospitais. Ele foi realizado em duas etapas. A primeira operação consistiu em ligadura do ramo direito da veia porta e bipartição hepática. Na segunda, os ramos direito da artéria hepática, via biliar e veia hepática foram ligados e o lobo hepático direito estendido foi removido.

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Regeneration After Two-Stage Hepatectomy vs Repeat Resection for Colorectal Metastasis Recurrence

Abstract: Two-stage hepatectomy is characterized by diminished hepatic regenerative capacity and postoperative liver function.

Cited by 22 publications

References 30 publications

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

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

„In-situ-Split“- (ISS) Leberresektion: Neue Aspekte zu Technik und Indikation

Ligadura da veia porta associada à bipartição do fígado para hepatectomia em dois estágios (ALPPS): experiência brasileira

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