scholarly journals First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

2020 ◽  
Vol 405 (3) ◽  
pp. 373-379
Author(s):  
Carina Riediger ◽  
Verena Plodeck ◽  
Johannes Fritzmann ◽  
Alexander Pape ◽  
Alexander Kohler ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Intraoperative Mri ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri ◽  
Staged Hepatectomy

Abstract Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

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

2018 ◽  
Vol 35 (4) ◽  
pp. 294-302 ◽  
Author(s):  
Hauke Lang ◽  
Janine Baumgart ◽  
Jens Mittler
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Tumor Recurrence ◽  
Controlled Trial ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Long Term Outcome ◽  
Staged Hepatectomy

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.

scholarly journals Role of associating liver partition and portal vein ligation in staged hepatectomy (ALPPS)—strategy for colorectal liver metastases

2018 ◽  
Vol 3 ◽  
pp. 66-66 ◽  
Author(s):  
Arezou Abbasi ◽  
Amir A. Rahnemai-Azar ◽  
Katiuscha Merath ◽  
Sharon M. Weber ◽  
Daniel E. Abbott ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Portal Vein Ligation ◽  
Staged Hepatectomy

Portal vein ligation with alcohol injection – our first experiences

2019 ◽  
Vol 98 (9) ◽  
pp. 379-384
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Absolute Alcohol ◽  
Alcohol Injection ◽  
Liver Remnant ◽  
Second Stage ◽  
Right Hemihepatectomy

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

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