Detailed Abstract
[Liver Oral Presentation 2 - Liver Disease/Surgery]
[LV OP 2-6] Two-stage hepatectomy combined with CRS and HIPEC: Initial experience
Jin Hong LIM1, Hyung Sun KIM1, Jun Seong PARK1, Dong Sup YOON2
1Department of Hepatobiliary and Pancreatic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea
2Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Korea, Korea
Introduction : Liver and peritoneum is most common metastatic lesion in patients with colorectal cancer. Synchronous bilobar colorectal cancer liver metastases(CCLM) and peritoneal metastases(PM) is known to be unresectable and dismal prognosis. However, although two stage hepatectomy(TSH) failure rate and incomplete cytoreductive surgery(CRS) rate is still high, TSH in patient with CCLM and cytoreductive surgery with heated intraperitoneal chemotherapy(HIPEC) in patient with PM have been adopted worldwide as alternative treatment strategy.
Methods : between 2017.03 and 2017.11, we have experienced six cases of TSH combined with CRS and HIPEC in our institution. Five patients received right hepatectomy after wedge resection and right portal vein ligation. One patient received associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).
Results : Preoperative Mean percentage of future liver remnant was measured as 24.2% (range 21.5~30.2%), mean liver hypertrophy period is 22.3 days (range 11~56 days). percentage of hypertrophied future liver remnant after first stage was measured as 37% (range 32.8~43.9%). Among six patients, three patient received CRS with HIPEC at first stage operation. other three patients received CRS with HIPEC at second stage operation. Complication rate (Clavien-Dinddo classification grade ≥3) was 33.3%. R0 resection of liver metastasis and complete cytoreduction of PM was achieved in all patients without mortality.
Conclusions : Simultaneous TSH and CRS with HIPEC is feasible and considered treatments in patients with Synchronous bilobar CCRM and PM. more patients’ enrollment was needed for evaluation of short and long-term outcome. Multimodal oncologic therapy can make important advances in the prognosis of these patients.
Methods : between 2017.03 and 2017.11, we have experienced six cases of TSH combined with CRS and HIPEC in our institution. Five patients received right hepatectomy after wedge resection and right portal vein ligation. One patient received associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).
Results : Preoperative Mean percentage of future liver remnant was measured as 24.2% (range 21.5~30.2%), mean liver hypertrophy period is 22.3 days (range 11~56 days). percentage of hypertrophied future liver remnant after first stage was measured as 37% (range 32.8~43.9%). Among six patients, three patient received CRS with HIPEC at first stage operation. other three patients received CRS with HIPEC at second stage operation. Complication rate (Clavien-Dinddo classification grade ≥3) was 33.3%. R0 resection of liver metastasis and complete cytoreduction of PM was achieved in all patients without mortality.
Conclusions : Simultaneous TSH and CRS with HIPEC is feasible and considered treatments in patients with Synchronous bilobar CCRM and PM. more patients’ enrollment was needed for evaluation of short and long-term outcome. Multimodal oncologic therapy can make important advances in the prognosis of these patients.
SESSION
Liver Oral Presentation 2
Room C 3/30/2018 11:30 AM - 12:20 PM