transection approach using bipolar and CUSA allows parenchymal sparing laparoscopic resections for patients, who may otherwise have been offered major resections of more than 70% of the hepatic parenchyma. Conclusion: This video demonstrates that colorectal liver metastases close to hepatic inflow and outflow can be approached using a laparoscopic parenchymal sparing approach.

and nausea. Eighteen years ago she underwent open cholecystectomy for acute cholecystitis. In the first post-operative days she was noted to be icteric. Abdominal ultrasound showed intrahepatic biliary ductal dilatation. Re-operation was indicated due to suspicion of iatrogenic common bile duct injury, which was confirmed intra-operatively at time of surgical re-exploration. Hepatico-jejunostomy (HJ) "non-Roux-en-Y" was performed. Despite this surgical biliary bypass, this patient continued to have recurrent bouts of cholangitis over the ensuing eighteen years. Given the patient's recurrent symptoms and results of MRI consistent with HL, surgical treatment was indicated. A left hepatectomy was performed with Roux-en-Y HJ biliary reconstruction. Post-operative course was uneventful. Patient is symptoms free without any attack of cholangitis. Conclusion:The primary goal in treating HL is to eradicate existing infection, recurrent cholangitis and subsequent hepatic fibrosis, prevent progression of the disease to cholangiocarcinoma. Hepatectomy and/or Roux-en-Y HJ is the best choice for treatment of HL.

Objective Hypoxia is present in most solid tumors and acts as a driver of malignancy. Myo-inositol trispyrophosphate (ITPP) is a novel re-oxygenating compound without apparent toxicity. In preclinical models, it potentiates the efficacy of subsequent chemotherapy through vascular normalization. We sought to assess the safety, tolerability, and preliminary efficacy of ITPP. Methods In this monocentric, open-label, dose-escalation study following a 3+3 design, eligible patients with advanced primary and secondary hepatopancreatobiliary tumors received nine 8-h infusions of ITPP during 3 weeks across eight dose levels (1866–14,500 mg/m2/dose), followed by standard chemotherapy. Primary endpoints were safety and tolerability. Secondary endpoints were pharmacokinetics and estimation of efficacy based on radiological responses and angiogenic serum markers. Registration number: NCT02528526. Results From April 2015 to July 2018, a total of 28 enrolled patients were assessed for the primary endpoints. ITPP was safe up to single doses of 12,390 mg/m2, and 32 ITPP-related adverse events occurred: 19 (67.8%) hypercalcemia, 5 (17.8%) hyponatremia, and 4 (14.2%) hypomagnesemia. Following ITPP monotherapy, 52% of patients displayed morphological disease stabilization. Following subsequent chemotherapy, 10% showed a partial response, and 60% had stable disease. Angiogenic markers were decreased in 60% after ITPP and tended to correlate with responses and survival after chemotherapy. Conclusion Administration of ITPP is safe up to 12,390 mg/m2 with favorable pharmacokinetics. Preliminary translational efficacy data show decreased angiogenic markers, which might indicate an anti-hypoxic effect and enhancement of chemotherapy through ITPP.

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Background: The effect of ALPPS on tumor proliferation, remains a concern. This study investigated the impact of ALPPS on growth of colorectal metastases in mice and human. Methods: The effect of ALPPS and 90% portal vein ligation (PVL) on colorectal liver and lung metastases was investigated in mice. In vivo tumor progression was assessed by magnetic resonance imaging (MRI), histology and survival experiments. The effects of ALPPS, PVL and control sera on colorectal cancer cells (MC38 and CT26) were tested in vitro. Additionally, the international ALPPS registry enabled to identify patients with remaining tumor in the future liver remnant (FLR) after ALPPS stage 1. Results: Two and three weeks after ALPPS stage 1, PVL or sham surgery, liver MRI showed similar intrahepatic tumor numbers ((p=0.14/0.82), sizes (p=0.45/0.98) and growth kinetics (p=0.58/0.68). Tumor growth was not different between ALPPS and PVL groups after completion of stage 2. Survival after tumor cell injection was similar after sham surgery and completion of ALPPS and PVL (36 days (IQR 32-40) vs. 42 days (IQR 36-48) vs. 39 days (IQR 35-42), p=0.237). Pulmonary metastases progression and in vitro cell proliferation were comparable among groups. Observations in humans failed to identify accelerated tumor growth in the FLR within the regenerative phase after ALPPS stage 1. Conclusion: The accelerated regeneration process associated to ALPPS does not enhance the growth of residual colorectal liver metastases.