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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 6/2015

01-08-2015 | Review Article

Staged resection of bilobar colorectal liver metastases: surgical strategies

Authors: Cui Yang, Nuh N. Rahbari, Sören Torge Mees, Felix Schaab, Moritz Koch, Jürgen Weitz, Christoph Reissfelder

Published in: Langenbeck's Archives of Surgery | Issue 6/2015

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Abstract

Background

Radical resection is the treatment of choice for colorectal liver metastases (CLM). Unfortunately, only about 20 % of patients present with initially resectable disease, in most cases due to bilobar disease. In the last two decades, major achievements have been made to extend surgical indications to patients with bilobar CLM, such as two-stage hepatectomy with or without portal vein occlusion and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).

Purpose

The purpose of this review article was to summarize current surgical approaches and their safety and efficacy for patients with initially unresectable bilobar CLM.

Conclusion

In selected patients, two-stage hepatectomy and ALPPS are efficient and safe to convert unresectable to resectable CLM. Further studies are required to evaluate long-term outcome of these procedures.
Literature
1.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108.CrossRefPubMed
2.
3.
Donadon M, Ribero D, Morris-Stiff G, Abdalla EK, Vauthey J-N (2007) New paradigm in the management of liver-only metastases from colorectal cancer. Gastrointest Cancer Res GCR 1(1):20–27PubMed
4.
Lam VWT, Laurence JM, Johnston E, Hollands MJ, Pleass HCC, Richardson AJ (2013) A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB 15(7):483–491PubMedCentralCrossRefPubMed
5.
Abdalla EK, Vauthey J-N, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239(6):818–825, discussion 825–827 PubMedCentralCrossRefPubMed
6.
Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Tabernero J, Teh C, Van Cutsem E, Jean-Nicolas Vauthey of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 17(10):1225–1239PubMedCentralCrossRefPubMed
7.
Aloia TA, Vauthey J-N (2011) Management of colorectal liver metastases: past, present, and future. Updat Surg 63(1):1–3CrossRef
8.
Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA (2006) Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13(10):1261–1268CrossRefPubMed
9.
Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231(4):487–499PubMedCentralCrossRefPubMed
10.
Reissfelder C, Rahbari NN, Bejarano LU, Schmidt T, Kortes N, Kauczor H-U, Büchler MW, Weitz J, Koch M (2014) Comparison of various surgical approaches for extensive bilateral colorectal liver metastases. Langenbecks Arch Surg Dtsch Ges Für Chir 399(4):481–491CrossRef
11.
Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232(6):777–785PubMedCentralCrossRefPubMed
12.
Wicherts DA, de Haas RJ, Andreani P, Sotirov D, Salloum C, Castaing D, Adam R, Azoulay D (2010) Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases. Br J Surg 97(2):240–250CrossRefPubMed
13.
Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M, Matsubara T, Takahashi T, Nakajima T, Muto T (2001) Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 181(2):153–159CrossRefPubMed
14.
Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y, DeMatteo RP, Blumgart LH, D’Angelica M (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247(1):109–117CrossRefPubMed
15.
Ritz J-P, Lehmann KS, Isbert C, Reissfelder C, Albrecht T, Stein T, Buhr HJ (2006) In-vivo evaluation of a novel bipolar radiofrequency device for interstitial thermotherapy of liver tumors during normal and interrupted hepatic perfusion. J Surg Res 133(2):176–184CrossRefPubMed
16.
Lee H, Heo JS, Cho YB, Yun SH, Kim HC, Lee WY, Choi SH, Choi DW (2015) Hepatectomy vs radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol WJG 21(11):3300–3307PubMed
17.
Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S (1986) Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 10(5):803–808CrossRefPubMed
18.
de Baere T, Denys A, Madoff DC (2007) Preoperative portal vein embolization: indications and technical considerations. Tech Vasc Interv Radiol 10(1):67–78CrossRefPubMed
19.
Kishi Y, Madoff DC, Abdalla EK, Palavecino M, Ribero D, Chun YS, Vauthey J-N (2008) Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 144(5):744–751CrossRefPubMed
20.
Madoff DC, Abdalla EK, Gupta S, Wu T-T, Morris JS, Denys A, Wallace MJ, Morello FA, Ahrar K, Murthy R, Lunagomez S, Hicks ME, Vauthey J-N (2005) Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol JVIR 16(2 Pt 1):215–225CrossRefPubMed
21.
Madoff DC, Hicks ME, Abdalla EK, Morris JS, Vauthey J-N (2003) Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness—study in 26 patients. Radiology 227(1):251–260CrossRefPubMed
22.
Mise Y, Aloia TA, Conrad C, Huang SY, Wallace MJ, Vauthey J-N (2015) Volume regeneration of segments 2 and 3 after right portal vein embolization in patients undergoing two-stage hepatectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract 19(1):133–141CrossRef
23.
Brouquet A, Abdalla EK, Kopetz S, Garrett CR, Overman MJ, Eng C, Andreou A, Loyer EM, Madoff DC, Curley SA, Vauthey J-N (2011) High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol Off J Am Soc Clin Oncol 29(8):1083–1090CrossRef
24.
Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber J-C, Bachellier P (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240(6):1037–1049, discussion 1049–1051 PubMedCentralCrossRefPubMed
25.
Tsim N, Healey AJ, Frampton AE, Habib NA, Bansi DS, Wasan H, Cleator SJ, Stebbing J, Lowdell CP, Jackson JE, Tait P, Jiao LR (2011) Two-stage resection for bilobar colorectal liver metastases: R0 resection is the key. Ann Surg Oncol 18(7):1939–1946CrossRefPubMed
26.
Jamal MH, Hassanain M, Chaudhury P, Tran TT, Wong S, Yousef Y, Jozaghi Y, Salman A, Jabbour S, Simoneau E, Al-Abbad S, Al-Jiffry M, Arena G, Kavan P, Metrakos P (2012) Staged hepatectomy for bilobar colorectal hepatic metastases. HPB 14(11):782–789PubMedCentralCrossRefPubMed
27.
Narita M, Oussoultzoglou E, Jaeck D, Fuchschuber P, Rosso E, Pessaux P, Marzano E, Bachellier P (2011) Two-stage hepatectomy for multiple bilobar colorectal liver metastases. Br J Surg 98(10):1463–1475CrossRefPubMed
28.
Elias D, De Baere T, Roche A, null Mducreux, 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(6):784–788CrossRefPubMed
29.
Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M, Ohta K, Yamaguchi T, Matsubara T, Takahashi T, Nakajima T, Muto T, Ikari T, Yanagisawa A, Kato Y (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatol Baltim Md 34(2):267–272CrossRef
30.
Seymour K, Manas D, Charnley RM (1999) During liver regeneration following right portal vein embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 86(11):1482–1483PubMed
31.
Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR (2009) Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer 100(4):617–622PubMedCentralCrossRefPubMed
32.
Fischer C, Melstrom LG, Arnaoutakis D, Jarnagin W, Brown K, D’Angelica M, Covey A, DeMatteo R, Allen P, Kingham TP, Tuorto S, Kemeny N, Fong Y (2013) Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy. JAMA Surg 148(12):1103–1108CrossRefPubMed
33.
Hoekstra LT, van Lienden KP, Doets A, Busch ORC, Gouma DJ, van Gulik TM (2012) Tumor progression after preoperative portal vein embolization. Ann Surg 256(5):812–817, discussion 817–818 CrossRefPubMed
34.
van Gulik TM, van den Esschert JW, de Graaf W, van Lienden KP, Busch ORC, Heger M, van Delden OM, Laméris JS, Gouma DJ (2008) Controversies in the use of portal vein embolization. Dig Surg 25(6):436–444CrossRefPubMed
35.
Beal IK, Anthony S, Papadopoulou A, Hutchins R, Fusai G, Begent R, Davies N, Tibballs J, Davidson B (2006) Portal vein embolisation prior to hepatic resection for colorectal liver metastases and the effects of periprocedure chemotherapy. Br J Radiol 79(942):473–478CrossRefPubMed
36.
Goéré D, Farges O, Leporrier J, Sauvanet A, Vilgrain V, Belghiti J (2006) Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg Off J Soc Surg Aliment Tract 10(3):365–370CrossRef
37.
Covey AM, Brown KT, Jarnagin WR, Brody LA, Schwartz L, Tuorto S, Sofocleous CT, D’Angelica M, Getrajdman GI, DeMatteo R, Kemeny NE, Fong Y (2008) Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg 247(3):451–455CrossRefPubMed
38.
Shindoh J, Truty MJ, Aloia TA, Curley SA, Zimmitti G, Huang SY, Mahvash A, Gupta S, Wallace MJ, Vauthey J-N (2013) Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg 216(2):201–209PubMedCentralCrossRefPubMed
39.
Reissfelder C, Rahbari NN, Koch M, Kofler B, Sutedja N, Elbers H, Büchler MW, Weitz J (2011) Postoperative course and clinical significance of biochemical blood tests following hepatic resection. Br J Surg 98(6):836–844CrossRefPubMed
40.
Aussilhou B, Lesurtel M, Sauvanet A, Farges O, Dokmak S, Goasguen N, Sibert A, Vilgrain V, Belghiti J (2008) Right portal vein ligation is as efficient as portal vein embolization to induce hypertrophy of the left liver remnant. J Gastrointest Surg Off J Soc Surg Aliment Tract 12(2):297–303CrossRef
41.
Kianmanesh R, Farges O, Abdalla EK, Sauvanet A, Ruszniewski P, Belghiti J (2003) Right portal vein ligation: a new planned two-step all-surgical approach for complete resection of primary gastrointestinal tumors with multiple bilateral liver metastases. J Am Coll Surg 197(1):164–170CrossRefPubMed
42.
Broering DC, Hillert C, Krupski G, Fischer L, Mueller L, Achilles EG, Schulte am Esch J, Rogiers X (2002) Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg Off J Soc Surg Aliment Tract 6(6):905–913, discussion 913 CrossRef
43.
Robles R, Marín C, Lopez-Conesa A, Capel A, Perez-Flores D, Parrilla P (2012) Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 38(7):586–593
44.
Wilms C, Mueller L, Lenk C, Wittkugel O, Helmke K, Krupski-Berdien G, Rogiers X, Broering DC (2008) Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model. Ann Surg 247(5):825–834CrossRefPubMed
45.
Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, Fichtner-Feigl S, Lorf T, Goralcyk A, Hörbelt R, Kroemer A, Loss M, Rümmele P, Scherer MN, Padberg W, Königsrainer A, Lang H, Obed A, Schlitt HJ (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255(3):405–414CrossRefPubMed
46.
Alvarez FA, Ardiles V, de Santibañes M, Pekolj J, de Santibañes E (2015) Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg 261:723–32CrossRefPubMed
47.
Ratti F, Schadde E, Masetti M, Massani M, Zanello M, Serenari M, Cipriani F, Bonariol L, Bassi N, Aldrighetti L, Jovine E (2015) Strategies to increase the resectability of patients with colorectal liver metastases: a multi-center case-match analysis of ALPPS and conventional two-stage hepatectomy. Ann Surg Oncol 22:1933–42CrossRefPubMed
48.
Clark ME, Smith RR (2014) Liver-directed therapies in metastatic colorectal cancer. J Gastrointest Oncol 5(5):374–387PubMedCentralPubMed
49.
Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, Soubrane O, Schnitzbauer AA, Raptis D, Tschuor C, Petrowsky H, De Santibanes E, Clavien P-A, ALPPS Registry Group (2014) Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg 260(5):829–836, discussion 836–838 CrossRefPubMed
50.
Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG, Hawkins IF, Vauthey J-N (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237(5):686–691, discussion 691–693 PubMedCentralPubMed
51.
Knoefel WT, Gabor I, Rehders A, Alexander A, Krausch M, Schulte am Esch J, Fürst G, Topp SA (2013) In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection. Br J Surg 100(3):388–394CrossRefPubMed
52.
Nagino M, Kamiya J, Kanai M, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y (2000) Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery 127(2):155–160CrossRefPubMed
53.
Torres OJM, de S. M. Fernandes E, Oliveira CVC, Lima CX, Waechter FL, Moraes-Junior JMA, Linhares MM, Pinto RD, Herman P, Machado MAC (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig ABCD Braz Arch Dig Surg 26(1):40–43CrossRef
54.
Petrowsky H (2015) Is partial-ALPPS safer than ALPPS? a single-center experience. Ann Surg 2015:2015
55.
Turrini O, Ewald J, Viret F, Sarran A, Goncalves A, Delpero J-R (2012) Two-stage hepatectomy: who will not jump over the second hurdle? Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 38(3):266–273
56.
Muratore A, Zimmitti G, Ribero D, Mellano A, Viganò L, Capussotti L (2012) Chemotherapy between the first and second stages of a two-stage hepatectomy for colorectal liver metastases: should we routinely recommend it? Ann Surg Oncol 19(4):1310–1315CrossRefPubMed
57.
Bowers KA, O’Reilly D, Bond-Smith GE, Hutchins RR (2012) Feasibility study of two-stage hepatectomy for bilobar liver metastases. Am J Surg 203(6):691–697CrossRefPubMed
58.
Tsai S, Marques HP, de Jong MC, Mira P, Ribeiro V, Choti MA, Schulick RD, Barroso E, Pawlik TM (2010) Two-stage strategy for patients with extensive bilateral colorectal liver metastases. HPB 12(4):262–269PubMedCentralCrossRefPubMed
59.
Tanaka K, Shimada H, Matsuo K, Ueda M, Endo I, Togo S (2007) Remnant liver regeneration after two-stage hepatectomy for multiple bilobar colorectal metastases. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 33(3):329–335
60.
Nadalin S, Capobianco I, Li J, Girotti P, Königsrainer I, Königsrainer A (2014) Indications and limits for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Für Gastroenterol 52(1):35–42CrossRef
61.
Aloia T, Sebagh M, Plasse M, Karam V, Lévi F, Giacchetti S, Azoulay D, Bismuth H, Castaing D, Adam R (2006) Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol Off J Am Soc Clin Oncol 24(31):4983–4990CrossRef
62.
Abdalla EK, Vauthey J-N (2008) Chemotherapy prior to hepatic resection for colorectal liver metastases: helpful until harmful? Dig Surg 25(6):421–429CrossRefPubMed
63.
Reissfelder C, Brand K, Sobiegalla J, Rahbari NN, Bork U, Schirmacher P, Büchler MW, Weitz J, Koch M (2014) Chemotherapy-associated liver injury and its influence on outcome after resection of colorectal liver metastases. Surgery 155(2):245–254CrossRefPubMed
Metadata
Title
Staged resection of bilobar colorectal liver metastases: surgical strategies
Authors
Cui Yang
Nuh N. Rahbari
Sören Torge Mees
Felix Schaab
Moritz Koch
Jürgen Weitz
Christoph Reissfelder
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 6/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-015-1310-2

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