How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective
Abstract Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overc...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-09-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12276 |
| _version_ | 1818722280874704896 |
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| author | Katsunori Imai René Adam Hideo Baba |
| author_facet | Katsunori Imai René Adam Hideo Baba |
| author_sort | Katsunori Imai |
| collection | DOAJ |
| description | Abstract Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two‐stage hepatectomy was introduced and has been adopted worldwide with acceptable short‐ and long‐term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two‐stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM. |
| first_indexed | 2024-12-17T20:52:07Z |
| format | Article |
| id | doaj.art-787d86293fc4439b9349070f9317f186 |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-12-17T20:52:07Z |
| publishDate | 2019-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-787d86293fc4439b9349070f9317f1862022-12-21T21:32:58ZengWileyAnnals of Gastroenterological Surgery2475-03282019-09-013547648610.1002/ags3.12276How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspectiveKatsunori Imai0René Adam1Hideo Baba2Department of Gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto JapanCentre Hépato‐Biliaire AP‐HP Hôpital Universitaire Paul Brousse Villejuif FranceDepartment of Gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto JapanAbstract Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two‐stage hepatectomy was introduced and has been adopted worldwide with acceptable short‐ and long‐term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two‐stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM.https://doi.org/10.1002/ags3.12276ALPPScolorectal liver metastasesconversion surgerytwo‐stage hepatectomy |
| spellingShingle | Katsunori Imai René Adam Hideo Baba How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective Annals of Gastroenterological Surgery ALPPS colorectal liver metastases conversion surgery two‐stage hepatectomy |
| title | How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective |
| title_full | How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective |
| title_fullStr | How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective |
| title_full_unstemmed | How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective |
| title_short | How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective |
| title_sort | how to increase the resectability of initially unresectable colorectal liver metastases a surgical perspective |
| topic | ALPPS colorectal liver metastases conversion surgery two‐stage hepatectomy |
| url | https://doi.org/10.1002/ags3.12276 |
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