The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

2020 ◽  
Vol 04 (03) ◽  
pp. 291-302
Author(s):  
Mariam F. Eskander ◽  
Christopher T. Aquina ◽  
Aslam Ejaz ◽  
Timothy M. Pawlik
Keyword(s):  
Colorectal Cancer ◽  
Portal Vein ◽  
Surgical Oncology ◽  
Portal Vein Ligation ◽  
Safe Alternative ◽  
Colorectal Cancer Liver Metastases ◽  
Liver Remnant ◽  
New Era ◽  
Ablation Therapy

AbstractAdvances in the field of surgical oncology have turned metastatic colorectal cancer of the liver from a lethal disease to a chronic disease and have ushered in a new era of multimodal therapy for this challenging illness. A better understanding of tumor behavior and more effective systemic therapy have led to the increased use of neoadjuvant therapy. Surgical resection remains the gold standard for treatment but without the size, distribution, and margin restrictions of the past. Lesions are considered resectable if they can safely be removed with tumor-free margins and a sufficient liver remnant. Minimally invasive liver resections are a safe alternative to open surgery and may offer some advantages. Techniques such as portal vein embolization, association of liver partition with portal vein ligation for staged hepatectomy, and radioembolization can be used to grow the liver remnant and allow for resection. If resection is not possible, nonresectional ablation therapy, including radiofrequency and microwave ablation, can be performed alone or in conjunction with resection. This article presents the most up-to-date literature on resection and ablation, with a discussion of current controversies and future directions.

scholarly journals Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections

2020 ◽  
pp. 1-8
Author(s):  
Yuzo Yamamoto
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Volume Ratio ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Ligation ◽  
Liver Remnant

<b><i>Background:</i></b> Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. <b><i>Summary:</i></b> FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, <sup>99m</sup>Tc-labeled galactosyl human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either <sup>99m</sup>Tc-GSA or <sup>99m</sup>Tc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. <b><i>Key Messages:</i></b> Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.

LIver Resection and role of Extended Histology (LiREcH study) in patients with multifocal colorectal cancer liver metastases

HPB ◽  
2021 ◽  
Author(s):  
Hassaan Bari ◽  
Umasankar M. Thiyagarajan ◽  
Rachel Brown ◽  
Keith J. Roberts ◽  
Nikolaos Chatzizacharias ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Cancer Liver Metastases

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 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

Associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in staged hepatectomy for hepatocellular carcinoma: A randomized comparative study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4578-4578
Author(s):  
Gang Huang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Portal Vein ◽  
Comparative Study ◽  
Risk Ratio ◽  
Portal Vein Embolization ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Staged Hepatectomy

4578 Background: Both Portal Vein Embolization (PVE) and Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) have been used in patients with unresectable hepatocellular carcinoma (HCC) due to insufficient volumes in future liver remnant (FLR). But it remains unclear for which thetapy has better long-term overall survival. Methods: This study was a single-center, prospective randomized comparative study. Patients were randomly assigned in a 1:1 ratio to the 2 groups. The primary endpoints was three-year overall survival rates. Results: Between November 2014 to June 2016, 76 patients with unresectable HCC due to inadequate volume of FLR were randomly assigned to ALPPS groups (n = 38) and PVE groups (n = 38). Thirty-seven patients (97.4%) in the ALPPS Group compared with 25 patients (65.8%) in the PVE Group were able to undergo staged hepatectomy (risk ratio 1.48, 95% CI 1.17-1.87, p < 0.001). The three-year overall survival (OS) rate of the ALPPS group (65.8%) (95% CI 50.7-80.9) was significantly better than the PVE Group (42.1%) (95% CI 26.4-57.8), (HR 0.50, 95% CI 0.26-0.98, two-sided p = 0.036). Major postoperative complications rates after the stage-2 hepatectomy were 54.1% in the ALPPS group and 20.0% in the PVE group ((risk ratio 2.70, 95% CI 1.17-6.25, p = 0.007). Conclusions: ALPPS resulted in significantly better long-term overall survival outcomes, at the expenses of a significantly higher perioperative morbidity rate compared with PVE in patients who had initially unresectable HCC. Clinical trial information: ChiCTR-IOC-14005646 .

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