scholarly journals Ex vivo liver resection for liver tumors: Last resort when conventional technique is not applicable

2021 ◽  
Vol 10 (2) ◽  
pp. 06-09
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Liver Resection ◽  
Liver Tumors ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Conventional Technique ◽  
Ex Situ ◽  
R0 Resection ◽  
Anatomical Site ◽  
Hepatic Neoplasms ◽  
Complications Rate

1. Purpose: The treatment of hepatic neoplasms has undergone, in recent years, various evolution of the surgical technique and extension to the indication for resection. Many patients with liver tumors cannot benefit from resection due to the difficulty of the anatomical site of the lesion.Of these patients, only some can benefit from ex vivo hepatic resection, which consists of a complete hepatectomy, bench tumor resection and self-transplant. 2. Materials and methods: We have retrospectively evaluated PUBMED databases. Studies was evaluated from 2010 to 2020.Only very few studies analyzed “Ex situ liver resection”, “Extracorporeal liver resection”, “Liver auto-transplantation”. Conclusion: Ex vivo liver resection and autotransplantation is fesible in very few patients with unresectable hepatic tumor fit for surgery. R0 resection accounts about 60%-90% but outcomes are less satisfactory due to high complications rate of about 25% and low survival in 3 years.

A multicenter phase II trial of mFOLFOX6 plus bevacizumab as treatment for liver-only metastases from colorectal cancer unsuitable for upfront resection (TRICC 0808).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 543-543
Author(s):  
Hiroyuki Uetake ◽  
Masamichi Yasuno ◽  
Megumi Ishiguro ◽  
Shingo Kameoka ◽  
Yasuhiro Shimada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Phase Ii ◽  
Conversion Rate ◽  
Phase Ii Trial ◽  
Liver Tumors ◽  
R0 Resection ◽  
Serum Total Bilirubin ◽  
Resection Rate ◽  
Grade 3

543 Background: Liver resection is a standard treatment for resectable liver metastases (mets) from colorectal cancer. In patients (pts) with multiple or large liver mets, liver tumors may not be resected completely or recurrence after complete resection are frequently observed. Methods: This prospective single arm phase II trial assessed R0 liver resection rate after mFOLFOX6 + bevacizumab (BV) in pts with liver mets considered unsuitable for upfront resection. Pts with liver-only mets, those were larger than 5cm in diameter or more than 4 in number, were treated with 6 cycles of mFOLFOX6 + BV (without BV in the 6th cycle). After chemotherapy, resectability of liver mets was assessed by CT or MRI. Secondary endpoints included liver resection rate, conversion rate from unresectable to resectable, safety of liver resection, recurrence rate, and survival. Results: Between May 2009 to October 2011, 46 pts were registered (one was excluded after registration due to ineligibility). Among the 19 pts with resectable mets at entry, 18, except one who refused the continuation of chemotherapy after the first cycle, underwent liver resection after 6 cycles of chemotherapy. In 16 of the 18 pts, R0 resection was performed. Among the 26 pts with unresectable mets at entry, 6 underwent liver resection and 4 had R0 resection. Overall R0 resection rate, liver resection rate and conversion rate were 44.4% (20/45), 53.3% (24/45) and 23.1% (6/26), respectively. The grade 3/4 adverse effects (AEs) by mFOLFOX6 + BV included fatigue (6.5%), stomatitis and nausea (2.2%), neutropenia (16.3%) and increase of serum total bilirubin (2.2%). As to BV related grade 3/4 AEs, hypertension (6.5%) and thromboembolism (2.2%) were observed. After liver resection, grade 3 wound infection, intra-abdominal abscess and delayed wound healing were complicated in two, in one and in one, respectively. Conclusions: In pts considered unsuitable for upfront resection of liver-only mets, mFOLFOX6 + BV was associated with high R0 resection rate, liver resection rate and conversion rate without severe toxicities and surgical complications. Updated results including survival will be presented. Clinical trial information: UMIN000002101.

Eight years after introducing liver resection at the Oncology Institute of Vojvodina

2013 ◽  
Vol 21 (3-4) ◽  
pp. 101-104
Author(s):  
Ivan Majdevac ◽  
Nikola Budisin ◽  
Milan Ranisavljevic ◽  
Dejan Lukic ◽  
Imre Lovas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Tumors ◽  
Liver Parenchyma ◽  
Malignant Neoplasms ◽  
Chemotherapy Treatment ◽  
Primary Liver Tumors ◽  
Cancer Metastases ◽  
Colorectal Cancer Metastases ◽  
Medical Histories

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

scholarly journals A safe and simple procedure for laparoscopic hepatectomy with combined diaphragmatic resection

2021 ◽  
Author(s):  
Keisuke Oyama ◽  
Shin Nakahira ◽  
Sakae Maeda ◽  
Akihiro Kitagawa ◽  
Yuki Ushimaru ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Laparoscopic Liver Resection ◽  
Liver Tumors ◽  
Simple Procedure ◽  
Laparoscopic Hepatectomy ◽  
Pleural Space ◽  
Absorbable Suture ◽  
Surgical Field

AbstractDiaphragmatic resection may be required beneath the diaphragm in some patients with liver tumors. Laparoscopic diaphragmatic resection is technically difficult to secure in the surgical field and in suturing. We report a case of successful laparoscopic hepatectomy with diaphragmatic resection. A 48-year-old man who underwent laparoscopic partial hepatectomy for liver metastasis of rectal cancer 20 months ago underwent surgery because of a new hepatic lesion that invaded the diaphragm. The patient was placed in the left hemilateral decubitus position. The liver and diaphragm attachment areas were encircled using hanging tape. Liver resection preceded diaphragmatic resection with the hanging tape in place. Two snake retractors were used to secure the surgical field for the inflow of CO2 into the pleural space after diaphragmatic resection. The defective part of the diaphragm was repaired using continuous or interrupted sutures. Both ends of the suture were tied with an absorbable suture clip without ligation. In laparoscopic liver resection with diaphragmatic resection, the range of diaphragmatic resection can be minimized by performing liver resection using the hanging method before diaphragmatic resection. The surgical field can be secured using snake retractors. Suturing with an absorbable suture clip is conveniently feasible.

The Role of Visceral Transplantation for Neoplastic Disease

2020 ◽  
Vol 04 (03) ◽  
pp. 273-281
Author(s):  
Masato Fujiki ◽  
Amit Nair ◽  
Giuseppe D'amico ◽  
Mohammed Osman
Keyword(s):  
Patient Survival ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Case Series ◽  
National Database ◽  
Neuroendocrine Neoplasms ◽  
Neoplastic Disease ◽  
Desmoid Tumors ◽  
Post Transplant ◽  
Recipient Tissue

AbstractVisceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

scholarly journals Хірургічне лікування місцево-розповсюджених та рецидивних солідних пухлин черевної порожнини та заочеревинного простору з нефректомією ex vivo ex situ та аутотрансплантацією нирки

2018 ◽  
Vol 85 (11) ◽  
pp. 61-64
Author(s):  
O. V. Vasylyev ◽  
S. S. Sikachyov ◽  
O. O. Kvasivka ◽  
V. I. Kopetskyi ◽  
D. O. Cheverdyuk ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Ex Situ

Мета. Покращення результатів лікування хворих з місцево-розповсюдженими та рецидивними солідними пухлинами черевної порожнини та заочеревинного простору.   Матеріали і методи. За період з червня 2015 по січень 2018 р. в Національному інституті раку виконали комбіновані оперативні втручання з нефректомією 28 хворим з приводу первинних місцево-розповсюджених та рецидивних солідних пухлин черевної порожнини та заочеревинного простору. Результати. У 5 із 28 пацієнтів виконали нефректомію ex vivo ex situ з аутотрансплантацією нирки, у 4 - успішно. Гостре ушкодження нирок спостерігали у 6 (26%) хворих, яким аутотрансплантації нирки не виконували. Після операції померли 2 (8,7%) хворих. У пацієнтів, яким нирка була збережена, не спостерігали гострого ушкодження нирок, ніхто з цих пацієнтів не помер. Висновки. З метою профілактики розвитку гострого ушкодження та хронічної хвороби нирок у майбутньому можливість виконання аутотрансплантації нирки у разі хірургічного лікування солідних пухлин черевної порожнини та заочеревинного простору, окрім первинного раку нирки, повинна бути розглянута щодо кожного хворого. Дану процедуру доцільно виконувати в спеціалізованих лікувальних закладах, де накопичено досвід в онковаскулярній хірургії.

scholarly journals Advances in the Resection and Reconstruction of Midfacial Tumors Through Computer Assisted Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Max Wilkat ◽  
Norbert Kübler ◽  
Majeed Rana
Keyword(s):  
Tumor Resection ◽  
Three Dimensional ◽  
Computer Assisted Surgery ◽  
Close Relation ◽  
Tissue Loss ◽  
R0 Resection ◽  
Computer Assisted ◽  
Oncologic Surgery ◽  
Complex Anatomy ◽  
Interdisciplinary Exchange

Curatively intended oncologic surgery is based on a residual-free tumor excision. Since decades, the surgeon’s goal of R0-resection has led to radical resections in the anatomical region of the midface because of the three-dimensionally complex anatomy where aesthetically and functionally crucial structures are in close relation. In some cases, this implied aggressive overtreatment with loss of the eye globe. In contrast, undertreatment followed by repeated re-resections can also not be an option. Therefore, the evaluation of the true three-dimensional tumor extent and the intraoperative availability of this information seem critical for a precise, yet substance-sparing tumor removal. Computer assisted surgery (CAS) can provide the framework in this context. The present study evaluated the beneficial use of CAS in the treatment of midfacial tumors with special regard to tumor resection and reconstruction. Therefore, 60 patients diagnosed with a malignancy of the upper jaw has been treated, 31 with the use of CAS and 29 conventionally. Comparison of the two groups showed a higher rate of residual-free resections in cases of CAS application. Furthermore, we demonstrate the use of navigated specimen taking called tumor mapping. This procedure enables the transparent, yet precise documentation of three-dimensional tumor borders which paves the way to a more feasible interdisciplinary exchange leading e.g. to a much more focused radiation therapy. Moreover, we evaluated the possibilities of primary midface reconstructions seizing CAS, especially in cases of infiltrated orbital floors. These cases needed reduction of intra-orbital volume due to the tissue loss after resection which could be precisely achieved by CAS. These benefits of CAS in midface reconstruction found expression in positive changes in quality of life. The present work was able to demonstrate that the area of oncological surgery of the midface is a prime example of interface optimization based on the sensible use of computer assistance. The fact that the system makes the patient transparent for the surgeon and the procedure controllable facilitates a more precise and safer treatment oriented to a better outcome.

scholarly journals Postoperative Adjuvant Radiotherapy Can Delay the Recurrence of Desmoid Tumors After R0 Resection in Certain Subgroups

2021 ◽  
Vol 8 ◽  
Author(s):  
Tielong Yang ◽  
Haotian Liu ◽  
Zhichao Liao ◽  
Chao Zhang ◽  
Lijie Xiang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Final Analysis ◽  
Postoperative Recurrence ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Desmoid Tumors ◽  
Entire Cohort ◽  
Single Tumor

Background: When patients with desmoid tumors (DTs) present uncontrolled clinical symptoms, surgery is an effective treatment, but the high postoperative recurrence rate is a major problem. The significance of adjuvant radiotherapy has been debated for many years, and the significance of aggressive surgery has not been reported.Methods: Medical records for DT patients were collected. KM analysis and the Mann–Whitney U-test were performed to evaluate the role of radiotherapy and aggressive surgery in the entire cohort and different subgroups.Results: Of 385 DT patients, 267 patients with R0 resection were included in the final analysis. A total of 53 patients (19.85%) experienced recurrence. Although radiotherapy showed no significant effect on recurrence-free survival (RFS) or time to recurrence (TTR) in the entire cohort, radiotherapy delayed recurrence in the age ≤ 30 years old subgroup (TTR = 35 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.014) and the tumor diameter >5 cm subgroup (TTR = 26 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.02) among patients with a single tumor. Aggressive surgery improved RFS in the tumor diameter >5 cm subgroup (p = 0.049) but not the entire cohort.Conclusions: Although radiotherapy cannot improve RFS, it can delay recurrence in the age ≤ 30 years old subgroup and the tumor diameter >5 cm subgroup among patients with a single tumor. For patients with large invasive tumors and multiple involved sites, aggressive surgery could be selected to achieve complete tumor resection to improve RFS.

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