Staged resection of bilobar colorectal liver metastases: surgical strategies

Yang, Cui; Rahbari, Nuh N.; Mees, Soeren Torge; Schaab, Felix; Koch, Moritz; Weitz, Jürgen; Reißfelder, Christoph

doi:10.1007/s00423-015-1310-2

Cited by 17 publications

(11 citation statements)

References 63 publications

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“…At present, hepatic resection is the only proven surgical procedure for curative purposes. With this intervention, operative mortality rates as low as 1e2% can be achieved [42,43]. Further, according to the evidence, an increasing number of elderly patients are presenting with CRC and being referred for surgical resection of LM [44,45].…”

Section: Discussionmentioning

confidence: 99%

Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Nardo

Serafini

Ruggiero

et al. 2016

International Journal of Surgery

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Liver resection for CRLM in carefully selected patients above the age of 75 can be performed with acceptable morbidity and mortality rates, similar to those in younger patients. Moreover, the severity of CRLM in elderly patients is proven to be lesser than in younger patients. Thus, we can conclude that advanced chronological age cannot be considered a contraindication to hepatic resection for CRLM.

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Section: Discussionmentioning

confidence: 99%

Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Nardo

Serafini

Ruggiero

et al. 2016

International Journal of Surgery

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“…Moreover, it was found that big tumours (>3cm), multiple metastases and non-anatomic (84,85). However, several studies have shown that in selected patients, similar outcomes can be achieved performing one-or two-stage liver resection (86)(87)(88)(89).…”

Section: Long-term Oncological Outcomes After Lpslr For Crlmmentioning

confidence: 99%

Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases

et al. 2021

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My special appreciation goes to a talented surgeon, my colleague and friend Dr. Åsmund Fretland, who has been a remarkable co-supervisor to me. Your research and surgical skills, positiveness and the ability to solve problems quickly have always impressed me. Thank you for letting me to take over your work in the OSLO-COMET trial and for introducing me to all the details. It is always my great pleasure to draft articles together with you, be your assistant at liver surgery and attend conferences together with you. My classmate, colleague and friend Dr. Mushegh Sahakyan deserves my deepest gratitude. You are a role model for me as a young talented and hard-working researcher. I have learned a lot from our discussions about surgical procedures, article drafting, methodologies and statistics in research. I am very glad that you are back to Norway and our research group. I look forward to continuing our fruitful cooperation and Armenian barbeques together. I would like to thank Prof. Erik Fosse for the opportunity to work at the Intervention Centre, where you have created an outstanding multi-speciality research team. Communication with multidisciplinary research teams and professionals at IVS have extended my horizons. It was my pleasure to work alongside Marianne Berg, Linda Engvik, nurses and radiology team.

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“…In particular, two-stage hepatectomy (TSH) with or without interstage chemotherapy, as well as portal vein embolization (PVE) of the contralateral lobe, is currently in use [11–13]. Waiting time between the two procedures is 8–12 weeks and 4–6 weeks after TSH and PVE, respectively [14]. Although significant improvement of resectability has been achieved with these techniques, a number of patients remain irresectable either because of an inappropriate increase in FLR or because of tumor progression during the waiting period until resection [13, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

et al. 2017

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BackgroundALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a novel two-stage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR. However, the effects of ALPPS on colorectal liver metastases (CRLM) are not clear so far. The aim of our study was to determine whether ALPPS induces proliferation, apoptosis, or vascularization compared to standard (one-stage) liver resection.MethodsSix patients who underwent ALPPS were matched with 12 patients undergoing standard liver resection regarding characteristics of the metastases (size, number), time of appearance (syn-/metachronous), preoperative chemotherapy, primary tumor (localization, TNM stage, grading), and patient variables (gender, age). The largest resected metastasis was used for the analyses. Tissue was stained for tumor cell proliferation (Ki67), apoptosis (TUNEL, caspase-3), vascularization (CD31), and pericytes (αSMA).ResultsVascularization (CD31; p = 0.149), proliferation (Mib-1; p = 0.244), and αSMA expression (p = 0.205) did not significantly differ between the two groups, although a trend towards less proliferation and αSMA expression was observed in patients undergoing ALPPS. Concerning apoptosis, caspase-3 staining showed significantly fewer apoptotic cells upon ALPPS (p < 0.0001), but this was not confirmed by TUNEL staining (p = 0.7344).ConclusionsALPPS does not induce proliferation, apoptosis, or vascularization of CRLM when compared to standard liver resection.

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Staged resection of bilobar colorectal liver metastases: surgical strategies

Abstract: In selected patients, two-stage hepatectomy and ALPPS are efficient and safe to convert unresectable to resectable CLM. Further studies are required to evaluate long-term outcome of these procedures.

Cited by 17 publications

References 63 publications

Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons

Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

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