Extreme Hepatic Surgery and Other Strategies

This book describes the diagnoses; staging and management of patients with colorectal liver metastases initially considered unresectable and portrays the different strategies to increase resectability along with their tactics and tricks. Colorectal carcinoma is the third most commonly diagnosed cancer in the world and according to recent cancer statistics around 1.23 million patients are diagnosed each year. Of these patients, approximately 50% will develop liver metastases during the course of their disease and around 15-25% are found to have stage IV disease at diagnosis. Liver resection has been recognized as the treatment of choice for these patients, offering overall 5-year survival rates of up to 50-60% and the only hope for cure. However, at diagnosis only 10-20% of these patients are possibly amenable to surgical resection with curative intent. The possibility to achieve an R0 resection is many times limited by the amount and quality of the future liver remnant (FLR), being posthepatectomy liver failure (PHLF) the most feared and severe complication after major liver resections. With the years, diverse strategies have been developed with the intention to increase resectability by increasing the future liver remnant and/or reducing tumor size, e.g. ALPPS. Along with these techniques, associated surgeries are developed including multivisceral resections, which broadens even more the resectability for patients.

Auteur
Eduardo de Santibañes MD, PhD, Full Professor of Surgery at University of Buenos Aires (2005-2013) and Full Professor and Head of the Surgery Department (Hospital Italiano, 2008-2012). Chairman of the General Surgery Service since 2005, one of the most active Surgical services of Latin America, having performed over 7,400 procedures in 2013. Chairman of the Liver Transplant Unit of the Hospital Italiano since 1985. Former Chairman of the World Congress of the Hepato Pancreato Biliary Association; Argentine Academy of Surgery, Argentine Association of Surgery, Argentine Liver Transplant Society and the Argentine Chapter of the International Hepato Pancreato Biliary Association. Honorary Member of the American Surgical Association, German Surgical Society, European Surgical Association, among others. Victoria Ardiles MD, PhD, General Surgeon (University of Buenos Aires), Laparoscopic Surgeon (Argentine Association of Surgery) and HPB surgeon (Hospital Italiano de Buenos Aires). Professorof Surgery at University of Buenos Aires and Associated Professor and Coordinator of the Surgery Department of the University School of Medicine, Hospital Italiano. Associated staff of the General Surgery Service, member of the Liver Transplant Unit and General coordinator of the Department of Surgery, Hospital Italiano de Buenos Aires. Martin de Santibañes Surgeon at Liver Transplantation and HPB Unit, Hospital Italiano de Buenos Aires. Assistant Professor Hospital Italiano de Buenos Aires School of Medicine. General Surgery Residency Co-Director, Hospital Italiano de Buenos Aires. Fernando Alvarez MD. Fellowship of HPB Surgery and Liver Transplant at the Italian Hospital of Buenos Aires (2013-2014). Received the "Eduardo F. Beláustegui Award" from the Argentine Surgical Association (2008) and the Annual Award" from the Argentine Academy of Surgery (2014). Virginia Cano Busnelli MD with Residency training at Italian Hospital of Buenos Aires.

Contenu

Part I Introduction. 1. Introduction.- 2. Liver surgical anatomy.- II. Global patient evaluation and oncological assessment.- 3. Resectability assessment with diagnostic imaging.- 4. Liver function evaluation before extreme liver surgery.- 5. Imaging-based preoperative planning.- 6. Choosing the best strategy. Multidisciplinary evaluation.- III.- Non-operative multimodal therapies.- 7. Conversion and neoadjuvant therapies.- 8. Portal embolization.- 9. Intraarterial chemotherapy.- 10. Radioembolization.- IV. Surgical strategies.- 11. Anesthetics management.- 12. Intraoperative evaluation of resectability.- 13. Vascular control in major hepatic resections.- 14. Two-stage liver surgery.- 15. Two-stage liver surgery with portal occlusion.- 16 ALPPS.- 17. Parenchymal-sparing liver resections.- 18. Combined vascular resections.- 19. Ex-vivo liver surgery.- 20. Liver transplant.- 21. The roll of laparoscopy in advanced liver disease.- V. Management of concomitant extrahepatic disease .- 22. Pulmonary metastases.- 23. Nodal involvement.- 24. Peritoneal disease.- 25. Adjacent organs invasion. Multivisceral resections.- VI. Postoperative complications and their management.- 26. Complications of hepatic resections.- VII. Palliative care.- 27. Palliative care in patients with extensive disease.