scholarly journals Two-stage liver resection for intrahepatic cholangiocarcinoma

2020 ◽  
Vol 25 (1) ◽  
pp. 106-112
Author(s):  
A. V. Chzhao ◽  
B. N. Gurmikov ◽  
V. A. Vishnevsky ◽  
A. A. Olifir ◽  
Ya. Ya. Gavrilov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Volume ◽  
Liver Parenchyma ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Alternative Version ◽  
The Right ◽  
Cholangiocellular Cancer

The small remnant liver volume remains an urgent problem in liver resection surgery. The use of the method of twostage liver resection – the Associated Liver Partition and Portal vein ligation for Staged hepatectomy in most cases allows to solve this problem. However, this method is associated with a number of complications and limitations. The presented clinical observation shows the effectiveness of an alternative version of this technology – radiofrequency ablation of the liver parenchyma in the plane of the proposed resection with ligation of the right branch of the portal vein to increase the volume of the estimated liver remnant in intrahepatic cholangiocellular cancer.

scholarly journals First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ming-Gen Hu ◽  
Jin Wang ◽  
Zhu-Zeng Yin ◽  
Rong Liu
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Falciform Ligament ◽  
Remnant Liver ◽  
Two Stage ◽  
Liver Remnant ◽  
Technical Aspects ◽  
Estimated Blood Loss ◽  
The Right

Abstract Background The associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) procedure is gaining interest because it brings hope to patients who cannot undergo radical surgical resection due to insufficient remnant liver volume. However, the indications and technical aspects of this procedure are still under debate. This report demonstrates the technical aspects of the first two-stage robotic ALPPS for HCC. Case presentation A 55-year-old man with type II portal vein variation was diagnosed with hepatocellular carcinoma. Preoperative 3D reconstruction of the liver based on CT showed a future liver remnant/standard liver volume (FLR/SLV) of 24.45%. The ALPPS procedure was performed using the da Vinci Si system. At the first stage of the operation, we removed the gallbladder and ligated the right anterior branch of the portal vein and the right posterior branch. Following blocking of the hepatic hilum, the liver parenchyma was removed 1 cm away from the right side of the falciform ligament in an incision manner from the top to the bottom and from shallow to deep. The second-stage operation was performed on the 12th postoperative day with a FLR/SLV of 45.13%. During this step, the right hemiliver plus left medial section was separated and removed. Postoperative pathology showed a negative margin. The operative times were 195 and 217 min, respectively. Estimated blood loss was 250 and 500 ml, respectively. There was no need for transfusion or hospitalization in intensive care. The patient was discharged on the 6th postoperative day. Recovery was uneventful after both stages, and the patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. The patient had no evidence of the disease 14 months after the procedure. Conclusions The two-stage robotic ALPPS procedure is a safe and feasible technique for select patients with HCC.

scholarly journals Preoperative Trans-catheter Arterial Chemoembolization and Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in Unresectable Hepatocellular Carcinoma – A Case Report

BioMedica ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 86-92
Author(s):  
Yilin Hu ◽  
Yanbing Shen ◽  
Dan Wang ◽  
Tingjia Cao
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Outcome ◽  
Portal Vein Ligation ◽  
The Right ◽  
Staged Hepatectomy ◽  
Arterial Chemoembolization

<p>Transcatheter arterial chemoembolization (TACE) is considered as a major method to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been used to treat patients with advanced HCC. This case report documents the safety, efficacy, and feasibility of TACE and laparoscopic ALPPS to treat the unresectable HCC of the right liver with right intra-hepatic metastasis in a male patient. Percutaneous and trans-femoral artery TACE was performed preoperatively, and the ALPPS stage-I at the 4th week and stage-II after 14 days was carried out. Postoperative outcome was assessed after 180 days of follow-up. It is concluded that preoperative TACE and laparoscopic ALPPS offer a fine treatment alternative to the patients with insufficient residual liver volume and relatively-advanced and extensive HCC.</p>

scholarly journals Right hepatectomy with preservation of the entire caudate lobe in patients with metastatic liver tumors: a case of a new hepatectomy technique and treatment strategy for patients with marginal liver function

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroyuki Kato ◽  
Yukio Asano ◽  
Masahiro Ito ◽  
Satoshi Arakawa ◽  
Norihiko Kawabe ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Indocyanine Green ◽  
Liver Volume ◽  
Caudate Lobe ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Indocyanine Green Clearance ◽  
The Right ◽  
Metastatic Liver

Abstract Background Performing major hepatectomy for patients with marginal hepatic function is challenging. In some cases, the procedure is contraindicated owing to the threat of postoperative liver failure. In this case report, we present the first case of marginal liver function (indocyanine green clearance retention rate at 15 min [ICGR15]: 28%) successfully treated with right hepatectomy, resulting in total caudate lobe preservation. Case presentation A 71-year-old man was diagnosed with sigmoid colon cancer with three liver metastases (S5, S7, and S8). All of metastatic lesions shrunk after chemotherapy, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12, respectively. Moreover, the remnant liver volume was only 39%. Therefore, portal venous embolism (PVE) of the right portal vein was suggested. Portography showed divergence of the considerably preserved right caudate lobe branch (PV1R) from the root of the right portal vein. The liver function was reevaluated 18 days after PVE was suggested. During this time, the ICGR15 (21–28%) and ICGK rate (0.12–0.10) deteriorated. The right caudate lobe was significantly enlarged; thus, a total caudate lobe-preserving hepatectomy (TCPRx) was performed. Patients eligible for TCPRx included those with (1) hepatocellular carcinoma or metastatic liver cancer, (2) no tumor in the caudate lobe, (3) marginal liver function (ICG Krem greater than 0.05 if TCPRx was adapted; otherwise, less than 0.05) and Child–Pugh classification category A, and (4) preserved PV1R and right caudate bile duct branch. The procedure was performed through (A) precise estimation of the remnant liver volume preoperatively, (B) repeated intraoperative cholangiography to confirm the biliary branch of the right caudate lobe (B1R) conservation, and (C) stapler division of posterior and anterior Glisson’s pedicles laterally to avoid injuries to the PV1R and B1R. Conclusions Right hepatectomy with total caudate lobe preservation, following PVE, was a safe and viable surgical technique for patients with marginal liver function.

Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the prospective remnant liver volume 705

2001 ◽  
Vol 120 (5) ◽  
pp. A90
Author(s):  
Christian Hillert ◽  
Dieter C. Broering ◽  
Gerrit Krupski ◽  
Matthias Gundlach ◽  
Xavier Rogiers
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Remnant Liver Volume

scholarly journals Assessment of Liver Function Using 99mTc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

2015 ◽  
Vol 9 (3) ◽  
pp. 353-360 ◽  
Author(s):  
Kasia P. Cieslak ◽  
Pim B. Olthof ◽  
Krijn P. van Lienden ◽  
Marc G. Besselink ◽  
Olivier R.C. Busch ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Portal Vein Ligation ◽  
Hepatobiliary Scintigraphy ◽  
Remnant Liver ◽  
Total Liver Volume ◽  
Second Stage ◽  
Staged Hepatectomy

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a new surgical technique for patients in whom conventional treatment is not feasible due to insufficient future remnant liver (FRL). During the first stage of ALPPS, accelerated hypertrophy of the FRL is induced by ligation of the portal vein and in situ split of the liver. In the second stage, the deportalized liver is removed when the FRL volume has reached ≥25% of total liver volume. However, FRL volume does not necessarily reflect FRL function. 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative test enabling regional assessment of parenchymal uptake function using a validated cut-off value for the prediction of postoperative liver failure (2.7%/min/m2). This paper describes the changes in FRL function and FRL volume in a 79-year-old patient diagnosed with metachronous colonic liver metastases who underwent ALPPS. We have observed a substantial difference between the increase in FRL volume and FRL function suggesting that HBS with SPECT-CT enables monitoring of the FRL function and could be a useful tool in the timing of resection in the second stage of the ALPPS procedure.

scholarly journals Case Report: Hepatic Artery Infusion Chemotherapy After Stage I ALPPS in a Patient With Huge HCC

2021 ◽  
Vol 8 ◽  
Author(s):  
Wenfeng Zhuo ◽  
Ang Li ◽  
Weibang Yang ◽  
Jinxin Duan ◽  
Jun Min ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Stage I ◽  
Hepatic Artery Infusion ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Infusion Chemotherapy ◽  
Hepatic Artery Infusion Chemotherapy ◽  
Staged Hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can induce rapid hypertrophy of the liver remnant. However, with a background of liver cirrhosis or other chronic liver diseases, patients with a huge hepatocellular carcinoma (HCC) may sometimes face insufficiency of hepatocellular regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Herein, we report a 56-year-old male with a vast HCC (13.3 × 8.5 × 13 cm) whose ratio of the future liver remnant (FLR)/standard liver volume (SLV) was 28.7% when the disease was first diagnosed. Inadequate hypertrophy of FLR was shown in postoperative volumetric assessment a month after stage I ALPPS. After multidisciplinary team discussion (MDT), the patient was decided to follow three courses of hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4). The last HAIC was performed together with transhepatic arterial embolization (TAE). Finally, ratio of the FLR/SLV increased from 28.7% to 40% during three-month intervals, meeting the requirements of the surgery. Stage II ALPPS, right trisectionectomy, was then successfully performed. There was no recurrence at half years of follow-up. In our case, HAIC seems to be more potent than transcatheter arterial chemoembolization (TACE) in maintaining the hyperplasia of the liver remnant, reducing tumor load, and preventing tumor progression in patients with a large HCC during ALPPS procedure. HAIC, following the first step of ALPPS, a pioneering treatment modality aiming for inadequate hypertrophy of FLR induced by ALPPS, could be an alternative procedure for patients with a vast HCC in clinical practice.

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