Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS
Staged hepatectomy is a promising strategy for curative resection of advanced colorectal liver metastasis (CRLM) to prevent inadequate future remnant liver (FRL). However, the selection criteria for conventional two-stage hepatectomy (cTSH) and associating liver partitioning and portal vein ligation...
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MDPI AG
2022-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/14/3553 |
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| author | Kun-Ming Chan Hao-Chien Hung Jin-Chiao Lee Tsung-Han Wu Yu-Chao Wang Chih-Hsien Cheng Chen-Fang Lee Ting-Jung Wu Hong-Shiue Chou Wei-Chen Lee |
| author_facet | Kun-Ming Chan Hao-Chien Hung Jin-Chiao Lee Tsung-Han Wu Yu-Chao Wang Chih-Hsien Cheng Chen-Fang Lee Ting-Jung Wu Hong-Shiue Chou Wei-Chen Lee |
| author_sort | Kun-Ming Chan |
| collection | DOAJ |
| description | Staged hepatectomy is a promising strategy for curative resection of advanced colorectal liver metastasis (CRLM) to prevent inadequate future remnant liver (FRL). However, the selection criteria for conventional two-stage hepatectomy (cTSH) and associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS) remain unclear. This study aimed to propose a selection criterion for determining the optimal staged hepatectomy for patients with advanced CRLM. A selection criterion based on the degree of metastatic tumors within the FRL was established to determine staged hepatectomy approaches. Generally, ALPPS is recommended for patients with ≤3 metastatic nodules and whose nodules do not measure >3 cm in the FRL. cTSH is performed for patients whose tumor burden in FRL beyond the selection criteria. Data of 37 patients who underwent staged hepatectomy and curative intent of CRLM were analyzed. The clinical characteristics and outcomes of the two approaches were compared. Overall, cTSH and ALPPS were performed for 27 (73.0%) and 10 (27.0%) patients, respectively. Of those, 20 patients in the cTSH group and all patients in the ALPPS group had completed staged hepatectomy. The 1-, 3-, and 5-year survival rates were 91.6%, 62.4%, and 45.4% for all patients, respectively. The outcomes of patients who had successfully completed the staged hepatectomy were significantly better than those of other patients who failed to achieve staged hepatectomy. However, no significant difference was observed in the overall survival of patients who underwent staged hepatectomy between the two groups, but those in the ALPPS group had 100% survival at the end of this study. The individualized selection criteria based on tumor burden in the FRL that could balance the operative risk and oncologic outcome appear to be a promising strategy for achieving complete staged hepatectomy in patients with advanced CRLM. |
| first_indexed | 2024-03-09T12:06:55Z |
| format | Article |
| id | doaj.art-ad8965d21a0d489c8761c3689facf1c8 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T12:06:55Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-ad8965d21a0d489c8761c3689facf1c82023-11-30T22:57:21ZengMDPI AGCancers2072-66942022-07-011414355310.3390/cancers14143553Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPSKun-Ming Chan0Hao-Chien Hung1Jin-Chiao Lee2Tsung-Han Wu3Yu-Chao Wang4Chih-Hsien Cheng5Chen-Fang Lee6Ting-Jung Wu7Hong-Shiue Chou8Wei-Chen Lee9Department of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanDepartment of General Surgery, Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan City 333, TaiwanStaged hepatectomy is a promising strategy for curative resection of advanced colorectal liver metastasis (CRLM) to prevent inadequate future remnant liver (FRL). However, the selection criteria for conventional two-stage hepatectomy (cTSH) and associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS) remain unclear. This study aimed to propose a selection criterion for determining the optimal staged hepatectomy for patients with advanced CRLM. A selection criterion based on the degree of metastatic tumors within the FRL was established to determine staged hepatectomy approaches. Generally, ALPPS is recommended for patients with ≤3 metastatic nodules and whose nodules do not measure >3 cm in the FRL. cTSH is performed for patients whose tumor burden in FRL beyond the selection criteria. Data of 37 patients who underwent staged hepatectomy and curative intent of CRLM were analyzed. The clinical characteristics and outcomes of the two approaches were compared. Overall, cTSH and ALPPS were performed for 27 (73.0%) and 10 (27.0%) patients, respectively. Of those, 20 patients in the cTSH group and all patients in the ALPPS group had completed staged hepatectomy. The 1-, 3-, and 5-year survival rates were 91.6%, 62.4%, and 45.4% for all patients, respectively. The outcomes of patients who had successfully completed the staged hepatectomy were significantly better than those of other patients who failed to achieve staged hepatectomy. However, no significant difference was observed in the overall survival of patients who underwent staged hepatectomy between the two groups, but those in the ALPPS group had 100% survival at the end of this study. The individualized selection criteria based on tumor burden in the FRL that could balance the operative risk and oncologic outcome appear to be a promising strategy for achieving complete staged hepatectomy in patients with advanced CRLM.https://www.mdpi.com/2072-6694/14/14/3553colorectal cancerliver metastasesstaged hepatectomytwo-stage hepatectomyALPPSfuture remnant liver |
| spellingShingle | Kun-Ming Chan Hao-Chien Hung Jin-Chiao Lee Tsung-Han Wu Yu-Chao Wang Chih-Hsien Cheng Chen-Fang Lee Ting-Jung Wu Hong-Shiue Chou Wei-Chen Lee Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS Cancers colorectal cancer liver metastases staged hepatectomy two-stage hepatectomy ALPPS future remnant liver |
| title | Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS |
| title_full | Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS |
| title_fullStr | Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS |
| title_full_unstemmed | Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS |
| title_short | Individualized Selection Criteria Based on Tumor Burden in Future Remnant Liver for Staged Hepatectomy of Advanced CRLM: Conventional TSH or ALPPS |
| title_sort | individualized selection criteria based on tumor burden in future remnant liver for staged hepatectomy of advanced crlm conventional tsh or alpps |
| topic | colorectal cancer liver metastases staged hepatectomy two-stage hepatectomy ALPPS future remnant liver |
| url | https://www.mdpi.com/2072-6694/14/14/3553 |
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