Two-stage hepatectomy for multiple bilobar colorectal liver metastases

Narita, Michiko; Oussoultzoglou, Elíe; Jaeck, Daniel; Fuchschuber, P; Rosso, Edoardo; Pessaux, Patrick; Marzano, Ettore; Bachellier, Philippe

doi:10.1002/bjs.7580

Cited by 124 publications

(118 citation statements)

References 46 publications

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“…This has been shown in several studies where up to 25–38% of patients did not proceed to step 2, mainly due to a tumor progression and less often due to an insufficient volume gain [11-17]. Patients who fail to complete stage 2 hepatectomy have a poor survival similar or even worse than patients treated with chemotherapy alone [11-16]. These data underline the importance of the completion of the planned 2 stage procedure and the necessity of a complete tumor clearance.…”

mentioning

confidence: 99%

“…Indeed, after PVE/PVL alone or in combination in the setting of TSH – with the latter having an even better chance to detect and remove small tumor deposits and metastases during step 1 – up to 24–41% of patients do not undergo stage 2 hepatectomy, mainly due to disease progression [12, 13, 16]. In an analysis by Narita of 80 intended and 61 performed TSH (dropout rate 24%), more than 2 CRLM detected in the FLR during step one were a negative predictor of not achieving the second step [16].…”

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confidence: 99%

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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

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Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon’s hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.

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confidence: 99%

mentioning

confidence: 99%

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

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“…, two sequentia mic resections a o 6 weeks and mass in the con val, although a ase in the mean and the secon olized hemi-liv and alcoholizat 51% [168,169] . P…”

Section: Portal Vein Occlusionmentioning

confidence: 96%

Metastatic lesions to the liver: Surgical indications and techniques

Tejedor¹,

Serrablo²

2013

JST

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Background: Although there is an established agreement on the advantage of liver resection for metastatic colorectal and neuroendocrine tumours, the role of hepatic surgery in patients with liver metastases from non-colorectal and non-neuroendocrine carcinoma is not well defined. In recent years, despite the poor results, liver metastases suitable for surgery have been treated with resection. The results reported in recent studies support a developing trend toward surgery in this setting. Also, as there are no data that in fact suggest the utility of alternative treatments for these lesions, the role of surgery is reinforced. Methods:A systematic search of English and non-English literature using MEDLINE on the outcomes of patients after surgical treatment of liver metastases from different solid tumours was undertaken. A summary of current surgical techniques used to improve their resectability has been added.Results: All papers reporting median survival and 5-year survival have been selected and presented in tables for most of the primary tumours reviewed. Conclusions:Apart from patients with colorectal and neuroendocrine tumours, liver resection may offer a significative survival advantage in selected patients, mainly those with metastases coming from breast, gastrointestinal stromal tumours, testis, ovary and kidney.

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“…During the wait prior to the second surgery, hypertrophy of the FLR was induced to make the second hepatectomy feasible and potentially curative (46). However, the major reason for failure of the twostage hepatectomy was tumor progression while waiting for hypertrophy of the FLR or an insufficient increase in volume after portal vein occlusion (47,48). In a recent review analyzing short-and long-term outcomes of a large series of two-stage hepatectomies, morbidity was reported to range between 20 and 60% after the second surgery and the drop-out rate was reported to range between 8 and 31% (49).…”

Section: Associating Liver Partition and Pvl For Staged Hepatectomy (mentioning

confidence: 99%

Recent advances in surgical treatment of hepatocellular carcinoma

Song

2015

DD&T

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Two-stage hepatectomy for multiple bilobar colorectal liver metastases

Abstract: A therapeutic strategy using TSH provided acceptable long-term survival with no postoperative mortality. Further efforts are needed to increase the number of patients who undergo TSH successfully.

Cited by 124 publications

References 46 publications

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Metastatic lesions to the liver: Surgical indications and techniques

Recent advances in surgical treatment of hepatocellular carcinoma

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