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Two stage hepatectomy

M A Machado, R Surjan, T Basseres, F Makdissi
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. PATIENT: A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment...
October 12, 2016: Annals of Surgical Oncology
L X Cai, S L He, F Q Wei, Y C Yu, X J Cai
Objective: The aim was to explore the strategy and clinical value of laparoscopic transection of median hepatic fissure (MHF) in difficult laparoscopic liver resections. Methods: First the MHF was located and marked, then the transection plane of the MHF was set. Next, the laparoscopic Multifuctional Operative Dissector (LPMOD) and the technique of curettage and aspiration were utilized to transect the liver beginning from the middle portion of the gallbladder fossa, in a caudal-to-cranial and anterior-to-posterior direction, until the clear exposure of the anterior surface of the intrahepatic inferior vena cava...
September 13, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
D Eshmuminov, D A Raptis, M Linecker, A Wirsching, M Lesurtel, P-A Clavien
BACKGROUND: Discussion is ongoing regarding whether associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) or portal vein occlusion is better in staged hepatectomy. The aim of this study was to compare available strategies using a two-stage approach in extended hepatectomy. METHODS: A literature search was performed in MEDLINE, Scopus, the Cochrane Library and Embase, and additional articles were identified by hand searching. Data from the international ALPPS registry were extracted...
September 16, 2016: British Journal of Surgery
Daisuke Kawaguchi, Yukihiko Hiroshima, Kenichi Matsuo, Itaru Endo, Keiji Koda, Kuniya Tanaka
AIM: To evaluate whether the congested area that develops in associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) contributes to rapid future liver remnant (FLR) hypertrophy. PATIENTS AND METHODS: Eight patients undergoing liver partition and right portal vein (RPV) ligation within the FLR in the first operation of ALPPS were compared with eight patients undergoing RPV embolization in the FLR as the first operation of classical two-stage (CTS) hepatectomy...
September 2016: Anticancer Research
Z G Hu, P B Huang, Z Y Zhou, C C He, H Y Zhang, W B Li, Z Y Xiao, J L Zhang, Y Y Xu, K Xu, C H Fang, J Wang
OBJECTIVE: To preliminarily explore the application value of two-dimensional image technology and three-dimensional visualization technology in hepatocellular carcinoma(HCC) treated by associating liver partition and portal vein ligation for staged hepatectomy(ALPPS). METHODS: Clinical data of nineteen HCC patients treated by ALPPS were retrospectively analyzed in Sun-Yat-Sen Memorial Hospital of Sun Yat-Sen University from August 2013 to May 2015.Preoperative assessment, surgical planning and intraoperative guidance were assisted by traditional two-dimensional imaging technology(group 2D) in 15 cases, and the rest 4 cases were assisted by three-dimensional visualization technology(group 3D)...
September 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
P P Li, H Liu, S Y Fu, C Lin, Z Y Pan, J Zhang, J S Ni, S X Yuan, W P Zhou
OBJECTIVE: To discuss the application of liver visualization technology in complex liver tumor resection at the second hepatic portal area. METHODS: Clinical data of 80 cases who received surgery at the second hepatic portal area from August 2014 to September 2015 in the Third Department of Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital were analyzed retrospectively. There were 58 male and 22 female patients aged from 21 to 70 years with median age of 52 years...
September 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Gaiping Wang, Congcong Zhao, Shasha Chen, Xiaofang Li, Ling Zhang, Cuifang Chang, Cunshuan Xu
Osteopontin (OPN) is a member of Th1 cytokine secreted by activated lymphocytes and macrophages. However, it deserves to be studied whether OPN could promote cell activation or proliferation, and then facilitate hepatic self-repair during liver regeneration (LR). This study is designed to further reveal the effects of OPN on LR in vivo. Firstly, quantitative reverse transcription-PCR (qRT-PCR) and western blot (WB) were utilized to validate the expression profile of endogenous OPN in rat regenerating livers after partial hepatectomy (PH)...
September 1, 2016: Molecular Biology Reports
Vivian Weiss, Julie Dueber, Jesse P Wright, Justin Cates, Frank Revetta, Alexander A Parikh, Nipun B Merchant, Chanjuan Shi
AIM: To investigate the role of the Wnt/β-catenin pathway in pancreatic neuroendocrine neoplasms (PanNENs). METHODS: Tissue microarrays containing 88 PanNENs were immunohistochemically labeled with antibodies to β-catenin, E-cadherin, adenomatous polyposis coli (APC), chromogranin and synaptophysin. One case had only metastatic tumors resected, whereas others (n = 87) received pancreatectomy with or without partial hepatectomy. Pathology slides, demographic, clinicopathologic, and follow up data were reviewed...
August 15, 2016: World Journal of Gastrointestinal Oncology
Ram Venkatesh Anantha, Christopher Ryan Shaler, Courtney Erin Meilleur, Jeremy Parfitt, S M Mansour Haeryfar, Roberto Hernandez-Alejandro
BACKGROUND AND AIMS: A short-interval, two-stage approach termed associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) increases the number of patients with extensive malignant disease of the liver and a small future liver remnant (FLR) that can undergo liver resection. While this approach results in accelerated liver hypertrophy of the FLR, it remains unknown whether this phenomenon is restricted to liver parenchymal cells. In the current study, we evaluated whether ALPPS alters the immunological composition of the deportalized lobe (DL) and the FLR...
2016: Frontiers in Medicine
R Adam, K Imai, C Castro Benitez, M-A Allard, E Vibert, A Sa Cunha, D Cherqui, H Baba, D Castaing
BACKGROUND: Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage hepatectomy is still unknown. METHODS: Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage hepatectomy for colorectal liver metastases in a single institution were included in the study...
October 2016: British Journal of Surgery
Long R Jiao, David N Hakim, Tamara M H Gall, Ana Fajardo, Tim D Pencavel, Ruifang Fan, Mikael H Sodergren
In order to induce liver hypertrophy to enable liver resection in patients with a small future liver remnant (FLR), various methods have been proposed in addition to portal vein embolisation (PVE). Most recently, the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique has gained significant international interest. This technique is limited by the high morbidity associated with an in situ liver splitting and the patient undergoing two open operations. We present the case of a variant ALPPS technique performed entirely laparoscopically with no major morbidity or mortality...
August 2016: Hepatobiliary Surgery and Nutrition
Yi-Fu Hou, Yong-Gang Wei, Jia-Yin Yang, Tian-Fu Wen, Ming-Qing Xu, Lu-Nan Yan, Bo Li
BACKGROUND: Combined hepatectomy and radiofrequency ablation (RFA) provides an additional treatment for patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) who are conventionally deemed unresectable. This study aimed to analyze the outcome of this combination therapy by comparing it with transarterial chemoembolization (TACE). METHODS: We retrospectively reviewed 51 patients with unresectable BCLC stage B HCC who had received the combination therapy...
August 2016: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Feng Zhong, Xin-Sheng Cheng, Kun He, Shi-Bo Sun, Jie Zhou, Hai-Ming Chen
BACKGROUND: Spontaneous rupture is one of the most fatal complications of HCC. The incidence of HCC still remains a significant health problem in Eastern Asia. Many studies have shown that the in-hospital or 30-day mortality rates are as high as 25-100 %. It is often difficult to stratify these patients based on clinical manifestations and biochemical data, for deciding on an appropriate treatment strategy, especially when the patient's hemodynamic status is unstable. This study aimed to explore the clinical outcomes of treatment of spontaneously ruptured hepatocellular carcinoma with hemorrhagic shock...
2016: SpringerPlus
Chun-Nan Yeh, Shang-Yu Wang, Yen-Yang Chen, Ming-Huang Chen, Kun-Chun Chiang, Chi-Tung Cheng, Chun-Yi Tsai, Chih-Chi Wang, Ta-Sen Yeh, Tse-Ching Chen
AIM: We hypothesized that a nomogram can accurately predict overall survival (OS) for patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy. MATERIALS AND METHODS: A nomogram to predict OS based was developed using data from 185 ICC patients who had undergone hepatectomy. The nomogram was evaluated by concordance index (C-index), as well as testing calibration of predicted OS with observed OS for both internal and external cohorts. RESULTS: Ten clinicopathological independent factors for OS prediction were selected for use in the nomogram...
August 2016: Anticancer Research
P Kambakamba, M Linecker, F A Alvarez, P Samaras, C S Reiner, D A Raptis, P Kron, E de Santibanes, H Petrowsky, P A Clavien, M Lesurtel
BACKGROUND: In patients undergoing two-stage hepatectomy (TSH) for colorectal liver metastases (CRLM), chemotherapy is discontinued before portal vein occlusion and restarted after curative resection. Long chemotherapy-free intervals (CFI) may lead to tumor progression and poor oncological outcomes. OBJECTIVE: The aim of this study was to investigate the impact of the length of CFI on oncological outcome in patients undergoing TSH for CRLM. PATIENTS AND METHODS: Overall, 74 patients suffering from bilobar CRLM who underwent ALPPS (associating liver partition with portal vein ligation for staged hepatectomy; n = 43) or conventional TSH (n = 31) at two tertiary centers were investigated...
July 18, 2016: Annals of Surgical Oncology
Lluis Palenzuela, Marc Oria, Jordi Romero-Giménez, Teresa Garcia-Lezana, Laia Chavarria, Juan Cordoba
Development of brain edema in acute liver failure can increase intracranial pressure, which is a severe complication of the disease. However, brain edema is neither entirely cytotoxic nor vasogenic and the specific action of the brain microvasculature is still unknown. We aimed to analyze gene expression of brain cortex microvessels in two rat models of acute liver failure. In order to identify global gene expression changes we performed a broad transcriptomic approach in isolated brain cortex microvessels from portacaval shunted rats after hepatic artery ligation (HAL), hepatectomy (HEP), or sham by array hybridization and confirmed changes in selected genes by RT-PCR...
July 12, 2016: Metabolic Brain Disease
L C Zattar-Ramos, R O Bezerra, L T Siqueira, D T Marques, M R Menezes, P Herman, M A C Machado, G G Cerri, C C Leite
PURPOSE: Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastasis (CRLM). Many multidisciplinary approaches, including the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, have been proposed to increase the resectability rate in these patients. ALPPS is the most recently described staged liver resection technique, representing an advantageous strategy to induce a rapid and marked increase in the future liver remnant (FLR) volume...
July 5, 2016: Abdominal Radiology
Hsueh-Chou Lai, Chun-Chieh Yeh, Long-Bin Jeng, Shang-Fen Huang, Pei-Ying Liao, Fu-Ju Lei, Wei-Chun Cheng, Cheng-Lung Hsu, Xiujun Cai, Chawnshang Chang, Wen-Lung Ma
PURPOSE: Although hepatectomy and liver transplantation surgery for hepatocellular carcinoma (HCC) are effective treatment modalities, the risk of recurrence remains high, particularly in patients with a high number of circulating tumor cells (CTCs) expressing cancer stem/progenitor cell markers. Androgen receptor (AR) signaling has been shown to suppress HCC metastasis in rodent models of HCC. In this study, we investigated whether AR is associated with postoperative HCC recurrence. EXPERIMENTAL DESIGN: CTCs were obtained from patients with HCC who had undergone hepatectomy to investigate whether they are associated with disease outcome...
June 20, 2016: Oncotarget
L Viganò, G Torzilli, M Cimino, K Imai, E Vibert, M Donadon, D Castaing, R Adam
BACKGROUND: Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal liver metastases (CLM), but 25-35% of patients fail to complete the scheduled procedure (drop-out). To elucidate if drop-out of TSH is a patient selection (as usually considered) or a loss of chance. METHODS: All the consecutive patients scheduled for a TSH at the Paul Brousse Hospital between 2000 and 2012 were considered. TSH patients were matched 1:1 with patients receiving a one-stage ultrasound-guided hepatectomy (OSH) at the Humanitas Research Hospital in the same period...
September 2016: European Journal of Surgical Oncology
Yu-Long Cai, Pei-Pei Song, Wei Tang, Nan-Sheng Cheng
The main obstacle to achieving an R0 resection after a major hepatectomy is inability to preserve an adequate future liver remnant (FLR) to avoid postoperative liver failure (PLF). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting tumors that were previously considered unresectable, and this technique results in a vast increase in the volume of the FLR in a short period of time. However, this technique continues to provoke heated debate because of its high mortality and morbidity...
June 2016: Medicine (Baltimore)
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