DOI: 10.25881/20728255_2021_16_3_36

Authors

Navmatulya A.Yu.1, Cikoridze M.Yu.1, Al’muhametova F.R.1, Caregorodcev A.E.1, Bratov O.Z.1, Savchuk S.A.1, Kuznecov A.I.1, Gel’fond V.M.1, Zagryadskih A.S.1, Chernobrivceva V.V.1, Miroshnikov B.I.1, Egorenkov V.V.1, Moiseenko V.M.1, Solov’ev I.A.3

1 Saint-Petersburg clinical scientific and practical center for specialized types of medical care (oncological), Saint-Petersburg

2 S.M. Kirov Military medical academy, St. Petersburg

3 Mariinsky Hospital, St. Petersburg

Abstract

Colorectal сancer is the third leading cause of cancer death in Russia. Upon initial detection of a tumor, synchronous liver metastases are detected in 30–50% of patients. Two-stage liver resection is often the only option for radical surgical treatment of patients with massive metastatic liver disease by preventing postresection liver failure.

Objective: to assess the possibility of ALPPS liver resections in patients with colorectal cancer metastases.

Material and methods. Extended hepatectomy according to the ALPPS was performed in 18 patients with massive bilobar liver lesions and with planned future liver remnants about ≤30%. The average patients’ age was 61.3±8.4 years. The first stage of surgical treatment included complete (n = 13) or partial (n = 5) liver splitting along the falciform ligament up to the inferior vena cava retrohepatic segment with portal vein right branch ligation. The second stage was an extended right-sided hepatectomy.

Results. Duration of the first stage was 171.6±55.5 min, blood loss was 170.9±87.8 ml. The second stage was performed after 58.2±26.7 days. The hypertrophy’s rate was 85.2±8.5%, and the remaining parenchyma volume to the liver total volume ratio increased from 21.06±2.4% to 33.1±2.8%. The second stage’s duration was 213.2±90.2 min, blood loss was 546.4±297.7 ml. Complications developed in 7 patients: acute liver failure (n = 2), biliary fistula (n = 3), common bile duct stricture (n = 1), liver resection edge bleeding (n = 1). 1 patient died in the postoperative period. The disease progression during the year was observed in 10 out of 17 patients (58.8%). The overall 1-year survival rate is 66.6%.

Conclusion. Two-stage liver resection ALPPS allows expanding the radical treatment possibility in patients with initially unresectable or conditionally unresectable colorectal cancer liver metastases.

Keywords: colorectal cancer, liver metastases, liver resection, extended right hepatectomy, ALPPS, acute liver failure.

References

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For citation

Navmatulya A.Yu., Cikoridze M.Yu., Al’muhametova F.R., Caregorodcev A.E., Bratov O.Z., Savchuk S.A., Kuznecov A.I., Gel’fond V.M., Zagryadskih A.S., Chernobrivceva V.V., Miroshnikov B.I., Egorenkov V.V., Moiseenko V.M., Solov’ev I.A. Two-stage liver resection ALPPS. Bulletin of Pirogov National Medical & Surgical Center. 2021;3(16):36-41. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_36