Innovative Surgical Approaches for Locally Advanced Hepatic Malignancy

2020 ◽  
Vol 04 (01) ◽  
pp. 046-052
Author(s):  
Young-Dong Yu ◽  
Dong-Sik Kim
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Portal Vein Ligation ◽  
Hepatic Malignancy ◽  
Term Survival ◽  
Advanced Malignancy

AbstractPrimary and secondary liver tumors are among the most common tumors in humans. Liver resection and liver transplantation are used to treat these malignancies. However, in many patients with locally advanced malignancy, it is not possible to resect these tumors using conventional techniques due to their enormous size or complex location. Refinements of surgical techniques have led to great improvements in terms of postoperative outcome and long-term survival in the past decades. This review explores innovative technologies in liver surgery, including both resection and transplantation, and their potential role in treating locally advanced hepatic malignancy. A number of innovative surgical techniques such as associating liver partition and portal vein ligation for liver surgery (ALPPS), ex vivo resection, ante situm liver resection, liver resection using extracorporeal hepatic venous bypass, and resection and partial liver segment 2/3 transplantation with delayed total hepatectomy (RAPID) have been developed to overcome the barriers of conventional liver resection and may offer acceptable outcomes for well-selected patients with locally invasive tumors that are otherwise inoperable by conventional techniques.

scholarly journals Vascular surgery in liver resection

2021 ◽  
Author(s):  
Olga Radulova-Mauersberger ◽  
Jürgen Weitz ◽  
Carina Riediger
Keyword(s):  
Liver Transplantation ◽  
Liver Resection ◽  
Vascular Surgery ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Vascular Reconstruction ◽  
Vascular Involvement ◽  
Term Survival ◽  
Long Term Survival

AbstractVascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery—despite being complex procedures—are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.

scholarly journals Giant Hepatic Carcinoid: A Rare Tumor with a Favorable Prognosis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Serge Landen ◽  
Maxime Elens ◽  
Celine Vrancken ◽  
Frederiek Nuytens ◽  
Thibault Meert ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Tumors ◽  
Locally Advanced ◽  
Term Survival ◽  
Large Size ◽  
Hepatic Carcinoid ◽  
Long Term Follow Up ◽  
Primary Origin

Primary hepatic carcinoids are rare tumors that are often diagnosed at a locally advanced stage. Their primary nature can only be ascertained after thorough investigations and long-term follow-up to exclude another primary origin. As with secondary neuroendocrine liver tumors, surgical resection remains the mainstay of therapy. Despite their large size and often central location liver resection is often feasible, offering long-term survival and cure to most patients. In selected patients liver transplantation appears to be a good indication for tumors not amenable to liver resection. An aggressive surgical attitude is therefore warranted. We report a large and unusually fast-growing liver carcinoid that appeared only marginally resectable in a patient who remains free of disease four years after surgery.

Colorectal Liver Metastasis

2019 ◽  
Author(s):  
Brian E Kadera ◽  
Michael D’Angelica
Keyword(s):  
Colorectal Cancer ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Hepatic Arterial Infusion ◽  
The United States ◽  
Surgical Approaches ◽  
Portal Vein Ligation ◽  
Arterial Infusion ◽  
Liver Remnant ◽  
Infusion Chemotherapy

Metastatic colorectal cancer isolated to the liver is a common clinical presentation in the United States, occurring in an estimated 50,000 patients per year. Unlike most stage IV malignancies, surgery is an effective mainstay of therapy. In the past several decades, novel surgical approaches, improved systemic chemotherapy, and locoregional therapies such as ablation and hepatic arterial infusion chemotherapy have broadened the indications for resection. At the same time, advances in perioperative care and adoption of parenchymal-sparing surgical techniques have lowered the perioperative mortality of liver resection to approximately 1%. Surgical cure is possible and using 10-year disease-free survival as a definition, this can be achieved in approximately 20 to 30% of well-selected patients. The majority of patients recur; thus, active surveillance is appropriate to identify patients for potential salvage therapy, including in some cases repeat resections and/or ablation, which is associated with prolonged survival and potential cure. More research is needed in biomarker drivers of prognosis, as there are few reliable clinicopathologic indicators to identify those in whom surgery will not benefit. This review contains 7 figures, 7 tables, and 90 references. Key Words: colorectal cancer, FOLFOX, FOLFIRI, hepatic arterial infusion, hepatic resection, liver remnant, microwave ablation, portal vein ligation, ALPPS

Colorectal Liver Metastasis

2019 ◽  
Author(s):  
Brian E Kadera ◽  
Michael D’Angelica
Keyword(s):  
Colorectal Cancer ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Hepatic Arterial Infusion ◽  
The United States ◽  
Surgical Approaches ◽  
Portal Vein Ligation ◽  
Arterial Infusion ◽  
Liver Remnant ◽  
Infusion Chemotherapy

Metastatic colorectal cancer isolated to the liver is a common clinical presentation in the United States, occurring in an estimated 50,000 patients per year. Unlike most stage IV malignancies, surgery is an effective mainstay of therapy. In the past several decades, novel surgical approaches, improved systemic chemotherapy, and locoregional therapies such as ablation and hepatic arterial infusion chemotherapy have broadened the indications for resection. At the same time, advances in perioperative care and adoption of parenchymal-sparing surgical techniques have lowered the perioperative mortality of liver resection to approximately 1%. Surgical cure is possible and using 10-year disease-free survival as a definition, this can be achieved in approximately 20 to 30% of well-selected patients. The majority of patients recur; thus, active surveillance is appropriate to identify patients for potential salvage therapy, including in some cases repeat resections and/or ablation, which is associated with prolonged survival and potential cure. More research is needed in biomarker drivers of prognosis, as there are few reliable clinicopathologic indicators to identify those in whom surgery will not benefit. This review contains 7 figures, 7 tables, and 90 references. Key Words: colorectal cancer, FOLFOX, FOLFIRI, hepatic arterial infusion, hepatic resection, liver remnant, microwave ablation, portal vein ligation, ALPPS

scholarly journals Surgical Options for Initially Unresectable Colorectal Liver Metastases

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Irinel Popescu ◽  
Sorin Tiberiu Alexandrescu
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Palliative Treatment ◽  
Survival Rates ◽  
Portal Vein Ligation ◽  
Term Survival ◽  
Number Of Patients ◽  
Unresectable Colorectal Liver Metastases ◽  
Surgical Options

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment.

scholarly journals Surgical Treatment of Sporadic Pancreatic Neuroendocrine Tumors: A State of the Art Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Sven-Petter Haugvik ◽  
Knut Jørgen Labori ◽  
Bjørn Edwin ◽  
Øystein Mathisen ◽  
Ivar Prydz Gladhaug
Keyword(s):  
Surgical Treatment ◽  
Neuroendocrine Tumors ◽  
Locally Advanced ◽  
Tumor Classification ◽  
Surgical Approaches ◽  
Pancreatic Neuroendocrine Tumors ◽  
Hormone Production ◽  
Term Survival ◽  
Histopathological Classification

Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.

scholarly journals Advances in the conventional clinical treatment for hepatoblastoma and therapeutic innovation

2021 ◽  
Vol 4 (3) ◽  
pp. e000220
Author(s):  
Zhixue Chen ◽  
Rui Dong
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Portal Vein ◽  
Molecular Mechanisms ◽  
Liver Tumors ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
New Treatments

BackgroundHepatoblastoma (HB) is a rare malignancy usually occurring in children under 3 years old. With advancements in surgical techniques and molecular biology, new treatments have been developed.Data resourcesThe recent literatures on new treatments, molecular mechanisms and clinical trials for HB were searched and reviewed.ResultsSurgical resection remains the main option for treatment of HB. Although complete resection is recommended, a resection with microscopical positive margins (R1) may have similar 5-year overall survival and 5-year event-free survival (EFS) rates after cisplatin chemotherapy and the control of metastasis, as only once described so far. Indocyanine green-guided surgery can help achieve precise resection. Additionally, associating liver partition and portal vein ligation for staged hepatectomy can rapidly increase future liver remnant volume compared with portal vein ligation or embolization. Cisplatin-containing chemotherapies slightly differ among the guidelines from the International Childhood Liver Tumors Strategy Group (SIOPEL), Children’s Oncology Group (COG) and Chinese Anti-Cancer Association Pediatric Committee (CCCG), and the 3-year EFS rate of patients in SIOPEL and CCCG studies was recently shown to be higher than that in COG studies. Liver transplantation is an option for patients with unresectable HB, and successful cases of autologous liver transplantation have been reported. In addition, effective inhibitors of important targets, such as the mTOR (mammalian target of rapamycin) inhibitor rapamycin, β-catenin inhibitor celecoxib and EpCAM (epithelial cell adhesion molecule) inhibitor catumaxomab, have been demonstrated to reduce the activity of HB cells and to control metastasis in experimental research and clinical trials.ConclusionThese advances in surgical and medical treatment provide better outcomes for children with HB, and identifying novel targets may lead to the development of future targeted therapies and immunotherapies.

scholarly journals A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

2019 ◽  
Vol 160 (33) ◽  
pp. 1304-1310
Author(s):  
Péter Lukovich ◽  
Balázs Pőcze ◽  
Jenő Nagy ◽  
Tamás Szpiszár ◽  
Alpár György ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Liver Resections ◽  
R1 Resection ◽  
Major Vessel ◽  
Histological Data

Abstract: Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304–1310.

scholarly journals The impact of portal vein tumor thrombus on long-term survival after liver resection for primary hepatic malignancy

HPB ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1025-1033 ◽  
Author(s):  
Fan Zhang ◽  
Chong-De Lu ◽  
Xiu-Ping Zhang ◽  
Zhen-Hua Chen ◽  
Cheng-Qian Zhong ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Portal Vein Tumor Thrombus ◽  
Hepatic Malignancy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

scholarly journals Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
F. Oldhafer ◽  
K. I. Ringe ◽  
K. Timrott ◽  
M. Kleine ◽  
W. Ramackers ◽  
...  
Keyword(s):  
Liver Resection ◽  
Ct Scan ◽  
Treatment Option ◽  
Intrahepatic Cholangiocarcinoma ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Typical Lesion ◽  
Intraoperative Conversion

Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combiningin situliver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC.Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient.Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

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