Τίτλος:
The ALPPS procedure as a novel "liver-first" approach in treating liver metastases of colon cancer: The first experience in Greek Cypriot area
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Despite recent advances in multimodality and multidisciplinary treatment of colorectal liver metastases, many patients suffer from extensive bilobar disease, which prevents the performance of a single procedure due to an insufficient future liver remnant (FLR). We present a novel indication for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a "liver-first" approach when inadequate FLR was faced preoperatively, in a patient with extensive bilobar liver metastatic disease of colon cancer origin. Case presentation: A 51-year-old lady was referred to our center due to a stage IV colon cancer with extensive bilobar liver disease and synchronous colon obstruction. During the multidisciplinary tumor board, it was recommended to proceed first in a palliative loop colostomy (at the level of transverse colon) operation and afterwards to offer her palliative chemotherapy. After seven cycles of chemotherapy, the patient was re-evaluated by CT scans that revealed an excellent response (> 30 %), but the metastatic liver disease was still considered inoperable. Moreover, with the completion of 12 cycles, the indicated restaging process showed further response. Subsequent to a thorough review by the multidisciplinary team, it was decided to proceed to the ALPPS procedure as a feasible means to perform extensive or bilobar liver resections, combined with a decreased risk of tumor progression in the interim. Conclusions: All in all, ALPPS can offer a feasible but surgically demanding liver-first approach with satisfactory short-term results in selected patients. Larger studies are mandatory to evaluate short- and long-term results of the procedure on survival, morbidity, and mortality. © 2016 Petrou et al.
Συγγραφείς:
Petrou, A.
Moris, D.
Kountourakis, P.
Fard-Aghaie, M.
Neofytou, K.
Felekouras, E.
Papalampros, A.
Περιοδικό:
World Journal of Surgical Oncology
Εκδότης:
BioMed Central Ltd.
Λέξεις-κλειδιά:
cetuximab; fluorouracil; folinic acid; irinotecan, adult; ALPPS procedure; Article; cancer chemotherapy; cancer growth; cancer palliative therapy; cancer staging; case report; colon cancer; colon obstruction; colostomy; computer assisted tomography; feasibility study; female; human; human tissue; liver metastasis; liver resection; middle aged; multiple cycle treatment; portal vein; preoperative period; surgical approach; surgical technique; transverse colon; treatment indication; treatment response; vein ligation; Colonic Neoplasms; Greece; hepatic portal vein; ligation; Liver Neoplasms; pathology; prognosis; vascular surgery, Colonic Neoplasms; Female; Greece; Hepatectomy; Humans; Ligation; Liver Neoplasms; Middle Aged; Portal Vein; Prognosis; Vascular Surgical Procedures
DOI:
10.1186/s12957-016-0827-3
