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Extended liver resection
Electronic Poster Abstracts
EP01C-103 TOTALLY LAPAROSCOPIC HEPATECTOMIES: A LOCAL REGIONAL HOSPITAL’S EXPERIENCE Y. -C. Shih and M. -C. Wu General Surgery, Cheng-Ching General Hospital Zhonggang Branch, Taiwan, ROC Introduction: Laparoscopic hepatecomy (LH) is now a wildly accepted procedure, the indication for LH has been largely extended. Here we reviewed our own experience for laparoscopic hepatectomy. Methods: From July 2012 to March 2015, fifty laparoscopic hepatectomies were performed in our hospital (a local regional hospital). All of these procedures were planned to be done by pure laparoscopic liver resection. Results: Of all 50 procedures, 2 (4%) cases were converted to laparotomy due to bleeding, 23 (46%) had previous abdominal surgeries (included 9 patients had previous open hepatectomy), 28 (56%) were major hepatectomies and 8 (16%) were right posterior segmentectomy. The average operation time was 368.04 (100w880) minutes, blood loss was 713 (50w5700) ml. Patient was discharged on postoperative day 9.08 (4w43). Thirty-nine (78%) of them were malignancy. There were 5 patients (10%) whose specimen cannot get free margin, included 4 had metastatic liver lesion, and surgery was done for down staging, and was known pre-operatively, while the rest of the patient was due to hepatic vein involvement. Complication occurred in 11 patients (22%), most common was biloma formation. There was one mortality (2%) who died 4 days after surgery due to suspicious of pulmonary embolism. Conclusion: Our result support that laparoscopic hepatectmy is a safe procedure even in patients who require major hepatectomy or with previous upper abdominal surgeries or laparotomy.
EP01C-104 ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY (ALPPS) IN PATIENTS WITH ADVANCED COLORECTAL LIVER METASTASES AND PREOPERATIVE CHEMOTHERAPY: A SINGLE CENTER EXPERIENCE F. Oldhafer1, F. Vondran1, K. Ringe2, K. Timrott1, M. Kleine1, W. Ramackers1, S. Cammann1, M. Jäger1, J. Klempnauer1 and H. Bektas1 1 Department of General, Visceral and Transplant Surgery, and 2Department of Diagnostic and Interventional Radiology, Hannover Medical School, Germany Introduction: Recently the ALPPS-procedure was developed to increase the resectability of marginally resectable or locally unresectable liver tumors. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and preoperative chemotherapy to further define suitable indications for this novel therapeutic concept. Methods: Retrospective analysis was performed on six patients suffering from advanced CRLM having received
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extensive preoperative chemotherapy. Analyses comprised demographical and basic clinical data, the perioperative courses as well as short- and long-term outcomes. Results: All patients presented with bilobular CRLM and a mean time of preoperative chemotherapy of 6 months (FOLFOX or FOLFORI based). Extended right hemihepatectomy was performed in all cases, 4 patients additionally received atypical resections in segments II/III. Mean future liver remnant was 397.8 cm3 (range: 121e 753 cm3) prior to step 1, with an increase to 808 cm3 (average increase of 67.9%, range: 32.5e94.1%) before completion of ALPPS. The interval between step I and II was 11 days (range: 9e14 days). Severe morbidity (Dindo Clavien >3a) occurred in 2 of the 6 patients. One patient died due to right hepatic artery thrombosis after step I. Following completion of ALPPS the mean disease-free survival was 174.0 days (range: 77e268 days) with an overall survival of 17 months (range: 5e31 months) at last follow-up. Conclusion: Despite extensive preoperative chemotherapy the ALPPS-procedure seems to result in adequate liver hypertrophy, successfully preventing postoperative smallfor-size syndrome. However, there might be a high risk of tumor recurrence in patients with an aggressive tumor biology.
EP01C-105 EXTENDED LIVER RESECTION I. Dzidzava, B. Kotiv, A. Slobodyanik, D. Kashkin, A. Smorodskiy and S. Soldatov Hospital Surgery, Military-Medical Academy named S.M. Kirov, Russian Federation The study included 78 patients who underwent hepatic resection. The first group consisted of patients who underwent extensive liver resection e 44 (56.4%). The second group included patients with small or sparing resection e 34. Various postoperative complications occurred in 29 (37.1%) cases (of which only 1 (1.3%) patients in the group with small resections). The most frequently observed postresection liver failure e 19 (24.35%) patients. With the expansion of the volume of intervention frequency liver dysfunction varying severity increased and reached 43%. Methodology of CT-volumetry with high precision allows to calculate the post-resection liver volume. Residual volume of liver parenchyma less than 359 cm3/m2 body surface is a predictor for the development of postoperative liver failure. Speed of the plasma elimination of ICG was sensitive (92.3%) and specificity (71.4%) by a quantitative evaluation of the functional reserves of the liver and characterized by a high potential predictor in determining postoperative liver failure in patients with chronic liver diseases, diagnosed with Class B and C by criteria ChildPugh, as well as the residual liver volume of at least 550 cm3/m2 body surface. Critical value for extensive liver resection is the speed of the plasma elimination ICG less than 10% / min. Using the methods for determining the functional reserve of the liver resections in the planning stage, allows for a differentiated approach to individual choice of treatment based on risk factors and interventions to improve the results of resection in patients with liver volume formation.
EP01C-103 TOTALLY LAPAROSCOPIC HEPATECTOMIES: A LOCAL REGIONAL HOSPITAL’S EXPERIENCE Y. -C. Shih and M. -C. Wu General Surgery, Cheng-Ching General Hospital Zhonggang Branch, Taiwan, ROC Introduction: Laparoscopic hepatecomy (LH) is now a wildly accepted procedure, the indication for LH has been largely extended. Here we reviewed our own experience for laparoscopic hepatectomy. Methods: From July 2012 to March 2015, fifty laparoscopic hepatectomies were performed in our hospital (a local regional hospital). All of these procedures were planned to be done by pure laparoscopic liver resection. Results: Of all 50 procedures, 2 (4%) cases were converted to laparotomy due to bleeding, 23 (46%) had previous abdominal surgeries (included 9 patients had previous open hepatectomy), 28 (56%) were major hepatectomies and 8 (16%) were right posterior segmentectomy. The average operation time was 368.04 (100w880) minutes, blood loss was 713 (50w5700) ml. Patient was discharged on postoperative day 9.08 (4w43). Thirty-nine (78%) of them were malignancy. There were 5 patients (10%) whose specimen cannot get free margin, included 4 had metastatic liver lesion, and surgery was done for down staging, and was known pre-operatively, while the rest of the patient was due to hepatic vein involvement. Complication occurred in 11 patients (22%), most common was biloma formation. There was one mortality (2%) who died 4 days after surgery due to suspicious of pulmonary embolism. Conclusion: Our result support that laparoscopic hepatectmy is a safe procedure even in patients who require major hepatectomy or with previous upper abdominal surgeries or laparotomy.
EP01C-104 ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY (ALPPS) IN PATIENTS WITH ADVANCED COLORECTAL LIVER METASTASES AND PREOPERATIVE CHEMOTHERAPY: A SINGLE CENTER EXPERIENCE F. Oldhafer1, F. Vondran1, K. Ringe2, K. Timrott1, M. Kleine1, W. Ramackers1, S. Cammann1, M. Jäger1, J. Klempnauer1 and H. Bektas1 1 Department of General, Visceral and Transplant Surgery, and 2Department of Diagnostic and Interventional Radiology, Hannover Medical School, Germany Introduction: Recently the ALPPS-procedure was developed to increase the resectability of marginally resectable or locally unresectable liver tumors. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and preoperative chemotherapy to further define suitable indications for this novel therapeutic concept. Methods: Retrospective analysis was performed on six patients suffering from advanced CRLM having received
HPB 2016, 18 (S1), e1ee384
e259
extensive preoperative chemotherapy. Analyses comprised demographical and basic clinical data, the perioperative courses as well as short- and long-term outcomes. Results: All patients presented with bilobular CRLM and a mean time of preoperative chemotherapy of 6 months (FOLFOX or FOLFORI based). Extended right hemihepatectomy was performed in all cases, 4 patients additionally received atypical resections in segments II/III. Mean future liver remnant was 397.8 cm3 (range: 121e 753 cm3) prior to step 1, with an increase to 808 cm3 (average increase of 67.9%, range: 32.5e94.1%) before completion of ALPPS. The interval between step I and II was 11 days (range: 9e14 days). Severe morbidity (Dindo Clavien >3a) occurred in 2 of the 6 patients. One patient died due to right hepatic artery thrombosis after step I. Following completion of ALPPS the mean disease-free survival was 174.0 days (range: 77e268 days) with an overall survival of 17 months (range: 5e31 months) at last follow-up. Conclusion: Despite extensive preoperative chemotherapy the ALPPS-procedure seems to result in adequate liver hypertrophy, successfully preventing postoperative smallfor-size syndrome. However, there might be a high risk of tumor recurrence in patients with an aggressive tumor biology.
EP01C-105 EXTENDED LIVER RESECTION I. Dzidzava, B. Kotiv, A. Slobodyanik, D. Kashkin, A. Smorodskiy and S. Soldatov Hospital Surgery, Military-Medical Academy named S.M. Kirov, Russian Federation The study included 78 patients who underwent hepatic resection. The first group consisted of patients who underwent extensive liver resection e 44 (56.4%). The second group included patients with small or sparing resection e 34. Various postoperative complications occurred in 29 (37.1%) cases (of which only 1 (1.3%) patients in the group with small resections). The most frequently observed postresection liver failure e 19 (24.35%) patients. With the expansion of the volume of intervention frequency liver dysfunction varying severity increased and reached 43%. Methodology of CT-volumetry with high precision allows to calculate the post-resection liver volume. Residual volume of liver parenchyma less than 359 cm3/m2 body surface is a predictor for the development of postoperative liver failure. Speed of the plasma elimination of ICG was sensitive (92.3%) and specificity (71.4%) by a quantitative evaluation of the functional reserves of the liver and characterized by a high potential predictor in determining postoperative liver failure in patients with chronic liver diseases, diagnosed with Class B and C by criteria ChildPugh, as well as the residual liver volume of at least 550 cm3/m2 body surface. Critical value for extensive liver resection is the speed of the plasma elimination ICG less than 10% / min. Using the methods for determining the functional reserve of the liver resections in the planning stage, allows for a differentiated approach to individual choice of treatment based on risk factors and interventions to improve the results of resection in patients with liver volume formation.