Rescue ALPPS: Intraoperative Conversion to ALPPS during Synchronous Resection of Rectal Cancer and Liver MetastasisReportar como inadecuado




Rescue ALPPS: Intraoperative Conversion to ALPPS during Synchronous Resection of Rectal Cancer and Liver Metastasis - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Case Reports in Surgery - Volume 2014 2014, Article ID 487852, 4 pages -

Case Report

Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA

Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA

Liver Center for Excellence, UH Digestive Health Institute, University Hospitals Case Medical Center, OH 44106, USA

Case Western Reserve University School of Medicine, OH 44106, USA

Received 17 September 2014; Accepted 10 November 2014; Published 24 November 2014

Academic Editor: Akihiro Cho

Copyright © 2014 Terence Jackson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Future liver remnant FLR is the most important deciding factor in planning for liver resection. Portal vein embolization PVE was first introduced in the 1980s to induce liver hypertrophy, enabling removal of multiple-bilobar tumors. PVE was later combined with sequential hepatectomies with the aim of allowing the liver remnant to hypertrophy 15–20% between procedures. However, the interval between the two procedures 3–8 weeks put patients at risk for disease progression. With portal vein ligation alone or when combined with sequential hepatectomy, there is also a risk for inadequate liver hypertrophy because of intrahepatic portal collaterals leading to a high 19–30% dropout rate. The ALPPS procedure associating liver partition and portal vein ligation for staged hepatectomy was recently developed as a feasible means to perform extensive-bilobar liver resections. It produces rapid, enormous hypertrophy of the remnant, making previously unresectable lesions resectable. Indications for ALPPS include any extensive liver resection with inadequate FLR. Here we present a novel indication for ALPPS as a rescue when inadequate FLR was faced intraoperatively, during a simultaneous resection of rectal primary and liver metastasis.





Autor: Terence Jackson, Kelly A. Siegel, and Christopher T. Siegel

Fuente: https://www.hindawi.com/



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