Heterotopic auxiliary segment 2–3 liver transplantation with delayed total hepatectomy: New strategies for nonresectable colorectal liver metastases

Ravaioli, Matteo; Fallani, Guido; Cescon, Matteo; Prosperi, Enrico; Pace, Vanessa De; Siniscalchi, Antonio; Sangiorgi, Gabriela; Ferracin, Manuela; Ardizzoni, Andrea; Morelli, Cristina; Garajová, Ingrid

doi:10.1016/j.surg.2018.05.021

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…Taking the concept of RAPID further, the Bologna group has recently reported the transplantation of such graft heterotopically into the splenic fossa [ 107 , 108 ]. This procedure is coined “hete R otopic tr A nsplantation of segments 2 and 3 using the splenic V ein and A rtery after S plenectomy and with delayed total hepatectomy“ (RAVAS) and necessitates a splenectomy before partial liver transplantation can be performed.…”

Section: Resection and Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy And Associated Conceptsmentioning

confidence: 99%

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Müller¹,

Linecker

Kırımker

et al. 2021

Langenbecks Arch Surg

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Background Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25–30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. Purpose The aim of this review is to depict the various interventions for liver parenchyma augmentation–assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. Conclusions To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly “palliative” disease into a curative and sometimes in a “chronic” disease.

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Section: Resection and Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy And Associated Conceptsmentioning

confidence: 99%

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Müller¹,

Linecker

Kırımker

et al. 2021

Langenbecks Arch Surg

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show abstract

“…The recipient had no portal hypertension but considering the low GRWR and the very complex surgery for 1‐stage transplantation, we proceeded with the planned intervention. As described in the previous article, 8 we would have performed a standard partial LT only if the GRWR was higher than 1%. Cryopreserved vascular grafts were anastomosed to the portal vein and the hepatic artery to lengthen the vessels.…”

Section: Case Reportmentioning

confidence: 99%

“…Considering a previous experience of heterotopic LT in the splenic fossa, 5‐7 we planned a novel procedure: heterotopic transplantation of segment 2‐3 in the splenic fossa, removing the spleen and modulating the native portal flow with delayed hepatectomy after regeneration of the transplanted graft 8 . The procedure of Heterotopic transplantation of segments 2 and 3 using the splenic vein and artery after splenectomy and with delayed total hepatectomy (RAVAS) was never reported.…”

Section: Introductionmentioning

confidence: 99%

Heterotopic segmental liver transplantation on splenic vessels after splenectomy with delayed native hepatectomy after graft regeneration: A new technique to enhance liver transplantation

Ravaioli

Brandi

Siniscalchi

et al. 2021

American Journal of Transplantation

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We describe a patient with liver metastases from colorectal cancer treated with chemotherapy and hepatic resection, who developed unresectable multifocal liver recurrence and who received liver transplantation using a novel planned technique: heterotopic transplantation of segment 2‐3 in the splenic fossa with splenectomy and delayed hepatectomy after regeneration of the transplanted graft. We transplanted a segmental liver graft after in‐situ splitting without any impact on the waiting list, as it was previously rejected for pediatric and adult transplantation. The volume of the graft was insufficient to provide liver function to the recipient, so we performed this novel operation. The graft was anastomosed to the splenic vessels after splenectomy, and the native liver portal flow was modulated to enhance graft regeneration, leaving the native recipient liver intact. The volume of the graft doubled during the next 2 weeks and the native liver was removed. After 8 months, the patient lives with a functioning liver in the splenic fossa and without abdominal tumor recurrence. This is the first case reported of a segmental graft transplanted replacing the spleen and modulating the portal flow to favor graft growth, with delayed native hepatectomy.

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“…In these patients, left lobectomy was deemed either not possible or unsafe, setting up the need for an alternative graft implantation site. Optimal venous outflow is paramount for liver regeneration in LT and the issue was addressed since the initial conception of the RAVAS technique 4 …”

Section: Figurementioning

confidence: 99%

Two surgical techniques are better than one: RAVAS and RAPID are answers for the same issue

Ravaioli

Fallani²,

Cerri

et al. 2021

American Journal of Transplantation

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Heterotopic auxiliary segment 2–3 liver transplantation with delayed total hepatectomy: New strategies for nonresectable colorectal liver metastases

Cited by 20 publications

References 16 publications

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Heterotopic segmental liver transplantation on splenic vessels after splenectomy with delayed native hepatectomy after graft regeneration: A new technique to enhance liver transplantation

Two surgical techniques are better than one: RAVAS and RAPID are answers for the same issue

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