Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 4/2009

Open Access 01-04-2009 | Original Article

Two-stage hepatectomy (R0) with portal vein ligation—towards curing patients with extended bilobular colorectal liver metastases

Authors: K. Homayounfar, T. Liersch, G. Schuetze, M. Niessner, A. Goralczyk, J. Meller, C. Langer, B. M. Ghadimi, H. Becker, T. Lorf

Published in: International Journal of Colorectal Disease | Issue 4/2009

Login to get access

Abstract

Background and aims

Patients with bilobular colorectal liver metastases (CRLM) experience poor prognosis, especially when curative resection cannot be achieved. However, resectability in these patients is often limited by low future remnant liver volume (FRLV). The latter can be enhanced by a two-stage liver resection, using portal vein ligation to induce liver hypertrophy. The aim of this prospective pilot study was to evaluate safety, secondary resectability, and time to recurrence of two-stage hepatectomy with portal vein ligation (PVL) and complete surgical clearance of the FRLV in patients with bilobular CRLM.

Materials and methods

Out of 24 patients (63 ± 8.26 years) with extended bilobular CRLM (metachronous n = 10, synchronous n = 14), 18 received preoperative 5-FU-based chemotherapy combined with oxaliplatin or irinotecan. Staging included thoracoabdominal computed tomography and 18F-fluorodeoxyglucose-positron emission tomography scans. First-stage procedure consisted of PVL, resection of all CRLM in the FRLV, and radiofrequency ablation (RFA) of CRLM situated near the future resection plane.

Results

During first-stage procedure, 7× RFA, 4× non-anatomical resections, and 4× bisegmentectomies were performed additionally to PVL. FRLV/body-weight ratio increased from 0.4% to 0.6% within 55 days (median) after PVL. Second-stage hepatectomy was performed in 19 patients without tumor progression. R0 resection was possible in 14 patients. During a median follow-up of 17 months, intrahepatic recurrence occurred in two, and extrahepatic recurrence in nine out of 14 patients.

Conclusion

Two-stage hepatectomy with PVL and complete surgical clearance of FRLV is safe even after intensified systemic chemotherapy resulting in a curative resection rate of 58.3% (73.7% of re-explored cases).
Literature
1.
Abdalla E, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–827PubMedCrossRef
2.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318PubMedCrossRef
3.
Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W et al (1994) Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 116:703–710PubMed
4.
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRef
5.
Adam R (2003) Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases. Ann Oncol 14(S2):ii13–16PubMed
6.
Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P (2004) A Two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobular colorectal liver metastases. Ann Surg 240:1037–1051PubMedCrossRef
7.
Gruttadauria S, Vasta F, Mivervini MI, Piazza T, Arcadipane A, Marcos A et al (2005) Significance of the effective remnant liver volume in major hepatectomies. Am Surg 71:235–240PubMed
8.
Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O et al (2007) Remnant liver volume to body weight ratio >0.5%: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204:22–33PubMedCrossRef
9.
Adam R, Delvart V, Pascal G, Azoulay D, Delvart V, Paule B et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240(6):644–657PubMedCrossRef
10.
Rous P, Larimore LD (1920) Relation of the portal blood to liver maintenance. J Exp Med 31:609–632PubMedCrossRef
11.
Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A et al (2000) Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231(4):480–486PubMedCrossRef
12.
Shaw IM, Rees M, Welsh FKS, Bygrave S, John TG (2006) Repeat hepatic resection for recurrent colorectal liver metastases is associated with favourable long-term-survival. Br J Surg 93:457–464PubMedCrossRef
13.
Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238(6):871–883PubMedCrossRef
14.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L et al (2000) New guidelines to evaluate the response to treatment in solid tumours. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92(3):205–216PubMedCrossRef
15.
Elias D, de Baere T, Roche A, Ducreux M, Leclere J, Lasser P (1999) During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 86:784–788PubMedCrossRef
16.
Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M et al (2001) Proliferative acitivity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34:267–272PubMedCrossRef
17.
Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–829PubMedCrossRef
18.
Goldenberg DM, Sharkey RM, Primus FJ (1976) Carcinoembryonic antigen in histopathology: immunoperoxidase staining of conventional tissue sections. J Natl Cancer Inst 57:11–22PubMed
19.
Gold P, Goldenberg NA (1997) The carcinoembryonic antigen (CEA): past present, and future. McGill J Med 3:46–66
20.
Goldenberg DM, Kim EE, DeLand FH, Bennett S, Primus FJ (1980) Radioimmunodetection of cancer with radioactive antibodies to carcinoembryonic antigen. Cancer Res 40:2984–2992PubMed
21.
Moffat FL Jr, Pinsky CM, Hammershaimb L, Petrelli NJ, Patt YZ, Whaley FS et al (1996) Clinical utility of external immunoscintigraphy with the IMMU-4 technetium-99 m Fab′ antibody fragment in patients undergoing surgery for carcinoma of the colon and rectum: results of a pivotal, phase III trial. The Immunomedics Study Group. J Clin Oncol 14(8):2295–2305PubMed
22.
Liersch T, Meller J, Kulle B, Behr TM, Markus P, Langer C et al (2005) Phase II trial of carcinoembryonic antigen radioimmunotherapy with 131I-labetuzumab after salvage resection of colorectal metastases in the liver: five-year safety and efficacy results. J Clin Oncol 23(27):6763–6770PubMedCrossRef
23.
Liersch T, Meller J, Bittrich M, Kulle B, Becker H, Goldenberg DM (2007) Update of carcinoembryonic antigen radioimmunotherapy with (131)i-labetuzumab after salvage resection of colorectal liver metastases: comparison of outcome to a contemporaneous control group. Ann Surg Oncol 14:2577–2590PubMedCrossRef
24.
Broering DC, Hillert C, Krupski G, Fischer L, Mueller L, Achilles EG et al (2002) Portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 6(6):905–913PubMedCrossRef
25.
Aussilhou B, Lesurtel M, Sauvanet A, Farges O, Dokmak S, Goasguen N et al (2007) Right portal vein ligation is as efficient as portal vein embolization to induce hypertrophy of the left liver remnant. J Gastrointest Surg 12(2):297–303 (Epub 2007 Nov 30)PubMedCrossRef
26.
Scaife CL, Ng CS, Ellis LM, Vauthey JN, Charnsangavej C, Curley SA (2006) Accuracy of preoperative imaging of hepatic tumours with helical computed tomography. Ann Surg Oncol 13:542–546PubMedCrossRef
27.
Wildi SM, Gubler C, Hany T, Petrowsky H, Clavien PA, Jochum W et al (2007) Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG-PET-CT. J Clin Ultrasound 36(1):20–26CrossRef
28.
Lygidakis NJ, Bhagat AD, Vrachnos P, Grigorakos L (2007) Challenges in everyday surgical practice: synchronous bilobular hepatic colorectal metastases—newer multimodality approach. Hepatogastroenterology 54:1020–1024PubMed
29.
Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197(2):233–241PubMedCrossRef
30.
van Duijnhoven FH, Jansen MC, Junggeburt JM, van Hillegersberg R, Rijken AM, van Coevorden F et al (2006) Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastases. Ann Surg Oncol 13(5):651–658PubMedCrossRef
31.
Park IJ, Kim HC, Yu CS, Kim PN, Won HJ, Kim JC (2008) Radiofrequency ablation for metachronous liver metastases from colorectal cancer after curative surgery. Ann Surg Oncol 15:227–232PubMedCrossRef
32.
Rubbia-Brandt L, Audard V, Sartoretti P, Roth AD, Brezault C, Le Charpentier M et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15(3):460–466PubMedCrossRef
33.
Karoui M, Penna C, Amin-Hashem M, Mitry E, Benoist S, Franc B et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243(1):1–7PubMedCrossRef
34.
Vauthey JN, Pawlik TM, Ribero D, Wu TT, Zorzi D, Hoff PM et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24(13):2065–2072PubMedCrossRef
35.
Tournigand C, Andre T, Achille E, Lledo G, Flesh M, Mery-Mignard D et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22(2):229–237PubMedCrossRef
36.
Selzner N, Pestalozzi BC, Kadry Z, Selzner M, Wildermuth S, Clavien PA (2006) Downstaging colorectal liver metastases by concomitant unilateral portal vein ligation and selective intra-arterial chemotherapy. Br J Surg 93:587–92PubMedCrossRef
37.
Sogaard KK, Astrup LB, Vilstrup H, Gronbaek H (2007) Portal vein thrombosis; risk factors, clinical presentation and treatment. BMC Gastroenterology 15:34CrossRef
38.
Makuuchi M, Hashikura Y, Kawasaki S, Tan D, Kosuge T, Takayama T (1993) Personal experience of right anterior segmentectomy (segments V and VIII) for hepatic malignancies. Surgery 114(1):52–58PubMed
39.
Elias D, Santoro R, Ouellet JF, Osmak L, de Baere T, Roche A (2004) Simultaneous percutaneous right portal vein embolization and left tumour radiofrequency ablation prior to a major right hepatic resection for bilateral colorectal metastases. Hepato-gastroenterol 51(60):1788–1791
40.
Folprecht G, Grothey A, Alberts S, Raab HR, Koehne CH (2005) Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 16(8):1311–1319PubMedCrossRef
41.
Mitry E, Fields ALA, Bleiberg H, Labianca R, Portier G, Tu D et al (2008) Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol 26(30):4906–4911PubMedCrossRef
42.
Covey AM, Brody LA, Getrajdman GI, Sofocleus CT, Brown KT (2004) Incidence, patterns, and clinical relevance of variant portal vein anatomy. Am J Roentgenol 183(4):1055–1064
Metadata
Title
Two-stage hepatectomy (R0) with portal vein ligation—towards curing patients with extended bilobular colorectal liver metastases
Authors
K. Homayounfar
T. Liersch
G. Schuetze
M. Niessner
A. Goralczyk
J. Meller
C. Langer
B. M. Ghadimi
H. Becker
T. Lorf
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 4/2009
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-008-0620-z

Other articles of this Issue 4/2009

International Journal of Colorectal Disease 4/2009 Go to the issue

Original Article

Intraperitoneally applied gentamicin increases collagen content and mechanical stability of colon anastomosis in rats

Original Article

Double primary malignancy in colorectal cancer patients—MSI is the useful marker for predicting double primary tumors

Original Article

Randomized controlled study between suture ligation and radio wave ablation and suture ligation of grade III symptomatic hemorrhoidal disease

Original Article

Aberrant crypt foci: endoscopic assessment and cell kinetics characterization

Original Article

Expression of tight and adherens junction proteins in ulcerative colitis associated colorectal carcinoma: upregulation of claudin-1, claudin-3, claudin-4, and β-catenin

Letter to the Editor

Acute pancolitis after colonoscopy in liver cirrhosis patient