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.

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.