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two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases:A case report

World Journal of Hepatology 2021年第2期13卷 261-268页

作者： Matteo Serenari Jacopo Neri Giovanni Marasco Cristina Larotonda Alberta Cappelli Matteo Ravaioli Cristina Mosconi Rita Golfieri Matteo Cescon General Surgery and Transplant Unit IRCCSAzienda Ospedaliero-Universitaria di BolognaSant'Orsola-Malpighi HospitalBologna 40138Italy Department of Medical and Surgical Sciences(DIMEC) University of BolognaBologna 40138Italy Department of Radiology IRCCSAzienda Ospedaliero-Universitaria di BolognaSant'Orsola-Malpighi HospitalBologna 40138Italy

BACKGROUND two-stage hepatectomy(TSH)is a well-established surgical technique,used to treat bilateral colorectal liver metastases(CRLM)with a small future liver remnant(FLR).However,in classical TSH,drop-out is reported to be around 25%-40%,due to insufficient FLR increase or progression of ***-arterial radioembolization(TARE)has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma,but it has been also reported to induce a certain degree of contralateral liver hypertrophy,even if at a lower rate compared to portal vein embolization or *** SUMMARY Herein we report the case of a 75-year-old female patient,where TSH and TARE were combined to treat bilateral *** to computed tomography(CT)-scan,the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment ***,one-stage posterior right sectionectomy plus left lateral sectionectomy(LLS)was *** liver volumetry estimated a FLR of 38%(segments I-IV-V-VIII).However,due to a more than initially planned,extended right resection,simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first *** CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%.Carcinoembryonic antigen and CA 19.9 decreased *** three months later after the first surgery,LLS was performed and the patient was discharged without any postoperative *** According to this specific experience,TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.

关键词： Trans-arterial Radioembolization two-stage hepatectomy Colorectal liver metastases Selective internal radiation therapy Yttrium90 Case report

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From conventional two-stage hepatectomy to ALPPS:Fifteen years of experience in a hepatobiliary surgery unit

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 542-550页

作者： Javier Maupoey Ibáñez Eva María MontalváOrón Andrea BoscàRobledo Alonso Camacho Ramírez Ana Hernando Sanz Pablo Granero Castro Alberto Alegre Delgado Rafael López-Andújar Hepatobiliary Surgery and Transplant Unit La Fe University and Polytechnic HospitalValenciaSpain Department of Radiology La Fe University and Polytechnic HospitalValenciaSpain

Background:hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma *** two-stage hepatectomy(TSH)and associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique are possible solutions to this *** 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 ***: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 *** was performed from January 2012 onwards as the technique of ***-term overall survival(OS)and disease-free survival(DFS)were evaluated as primary outcome in CRLM *** morbidity,mortality and liver growth in all patients were also ***:A total of 38 staged hepatectomies were performed:17 TSH and 21 *** 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≥3 a)(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%,*** rates at 1 and 5 years were 36%and 27%in the TSH group vs.33%and 27%in the ALPPS group,***:ALPPS is an effective alternative to TSH in bilateral affecting liver tumors,allowing higher resection rate,but patients must be carefully *** CRLM patients similar long-term OS and DFS can be achieved with both techniques.

关键词： ALPPS two-stage hepatectomy Colorectal liver metastases Posthepatectomy liver failure

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Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

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World Journal of Gastroenterology 2011年第30期17卷 3554-3559页

作者： Hiroya Iida Chiaki Yasui Tsukasa Aihara Shinichi Ikuta Hidenori Yoshie Naoki Yamanaka Department of Surgery Meiwa Hospital 4-31 Agenaruo-choNisinomiya663-8186 HyogoJapan

hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer;however,one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver,which may cause postoperative liver *** induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver,procedures to occlude the portal vein have been conventionally used prior to major *** report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic *** procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique,and to the best of our knowledge,it was used for the first time in the present *** successful induction of liver volume shift as well as the following procedure,the patient died of subsequent liver failure after developing recurrent *** discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

关键词： two-stage hepatectomy Bile duct ligation Portal vein ligation Synchronous liver metastases

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One-versus two-stage partial hepatectomy for large resectable solitary hepatocellular carcinomas determined preoperatively to have a narrow resection margin:a propensity score matching analysis

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 662-674页

作者： Yao Li Peng-Peng Li Da-Peng Sun Jun-Sheng Ni Hui Liu Ze-Ya Pan Yuan Yang Ling-Hao Zhao Wan Yee Lau Gang Huang Wei-Ping Zhou The Third Department of Hepatic Surgery Eastern Hepatobiliary Surgery HospitalShanghaiChina Faculty of Medicine The Chinese University of Hong KongPrince of Wales HospitalShatinHong KongChina Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer(SMMU) Ministry of EducationShanghaiChina Shanghai Key Laboratory of Hepatobiliary Tumor Biology(EHBH) ShanghaiChina

Background:For patients with a large but resectable solitary hepatocellular carcinoma(HCC)of>5 cm in diameter,it is often difficult to achieve a sufficient resection *** is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be ***:From August 2014 to February 2017,patients with a large but resectable solitary HCC of>5 cm and a preoperative estimated resection margin oftwo-stage resection groups.A retrospective analysis was performed,followed by propensity score matching(PSM)*** recurrence,survival,intraoperative and postoperative data were ***:Before PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.3%,31.7%,24.3%,19.2%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.007).The corresponding OS rates were 61.0%,45.2%,43.8%,38.4%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.029).After PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.0%,31.5%,27.3%,21.0%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.013).The corresponding OS rates were 62.5%,41.1%,41.1%,37.5%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.038).Differences in the resection margins between the one-and two-stage groups before[0.3(0-0.5)versus 1.2(0.8-2.2)cm]and after[0.2(0-0.5)versus 1.2(0.8-2.2)cm]PSM were also ***:two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of>5 cm,and resulted in significantly better long-term survival outcomes after partial hepatectomy.

关键词： One-stage hepatectomy two-stage hepatectomy large solitary hepatocellular carcinoma(HCC) resection margin

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Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of colorectal cancer liver metastases

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 814-821页

作者： Xu-Dong Wen Le Xiao Department of Gastroenterology and Hepatology Chengdu First People's HospitalChengdu 610016Sichuan ProvinceChina General Surgery Center The General Hospital of Western Theater CommandChengdu 610083Sichuan ProvinceChina

Colorectal cancer(CRC)is a common malignancy of the digestive *** liver cancer metastasis(CRLM)occurs in approximately 50%of the patients and is the main cause of CRC *** resection is currently the most effective treatment for ***,given that the remnant liver volume after resection should be adequate,only a few patients are suitable for radical *** *** Schlitt first performed the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for CRLM in 2012,ALPPS has received considerable attention and has continually evolved in recent *** review explains the technical origin of the ALPPS procedure for CRLM and evaluates its efficacy,pointing to its favorable postoperative *** also discuss the patient screening strategies and optimization of ALPPS to ensure long-term survival of patients with CRLM in whom surgery cannot be ***,further directions in both basic and clinical research regarding ALPPS have been *** ALPPS surgery is a difficult and high-risk technique,it is still worth exploration by experienced surgeons.

关键词： Associating liver partition and portal vein ligation for staged hepatectomy Colorectal liver cancer metastases Portal embolization Portal ligation two-stage hepatectomy

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Comparison of percutaneous transhepatic portal vein embolization and unilateral portal vein ligation

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World Journal of Gastroenterology 2012年第19期18卷 2371-2376页

作者： Hiroya Iida Tsukasa Aihara Shinichi Ikuta Hidenori Yoshie Naoki Yamanaka Department of Surgery Meiwa Hospital 4-31 Agenaruo-choNisinomiyaHyogo 663-8186Japan

AIM： To compare the effect of percutaneous transhepatic portal vein embolization （PTPE） and unilateral portal vein ligation （PVL） on hepatic hemodynamics and right hepatic lobe （RHL） atrophy.METHODS： Between March 2005 and March 2009, 13 cases were selected for PTPE （n = 9） and PVL （n = 4） in the RHL. The PTPE group included hilar bile duct carcinoma （n = 2）, intrahepatic cholangiocarcinoma （n = 2）, hepatocellular carcinoma （n = 2） and liver metastasis （n = 3）. The PVL group included hepatocellular carcinoma （n = 2） and liver metastasis （n = 2）. In addition, observation of postoperative hepatic hemodynamics obtained from computed tomography and Doppler ultrasonography was compared between the two groups.RESULTS： Mean ages in the two groups were 58.9 ± 2.9 years （PVL group） vs 69.7 ±3.2 years （PTPE group）, which was a significant difference （P = 0.0002）. Among the indicators of liver function, including serum albumin, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, platelets and indocyanine green retention rate at 15 min, no significant differ- ences were observed between the two groups. Preop-erative RHL volumes in the PTPE and PVL groups were estimated to be 804.9 ±181.1 mL and 813.3 4±129.7 mL, respectively, with volume rates of 68.9% ± 2.8% and 69.2% ±4.2%, respectively. There were no significant differences in RHL volumes （P = 0.83） and RHL volume rates （P = 0.94）, respectively. At 1 mo after PTPE or PVL, postoperative RHL volumes in the PTPE and PVL groups were estimated to be 638.4±153.6 mL and 749.8 ± 121.9 mL, respectively, with no significant difference （P = 0.14）. Postoperative RHL volume rates in the PTPE and PVL groups were estimated to be 54.6% ± 4.2% and 63.7% ± 3.9%, respectively, which was a significant difference （P = 0.0056）. At 1 mo after the operation, the liver volume atrophy rate was 14.3% ± 2.3% in the PTPE group and 5.4%± 1.6% in the PVL group, which was a significant difference （P = 0.0061）.CONCLUSION： PTPE is a

关键词： Percutaneous transhepatic portal vein em-bolization Portal vein ligation Liver atrophy Futureliver remnant two-stage hepatectomy

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