Abstract
Surgical strategy is the key to successful treatment of patients with colorectal liver metastases. The use of intraoperative ultrasonography has become mandatory at the beginning of the operation, as it allows better staging of the disease but also during every step of the resection, guiding the hepatectomy such that it is safer and easier. Intraoperative ultrasonography makes parenchyma-sparing resections possible, improving the likelihood of better preserved postoperative liver function, decreasing the risk of liver dysfunction, and facilitating re-resection in case of hepatic recurrences. The role of laparoscopic resection is still debated, but its potential advantages include the fact that it offers a minimally invasive approach for selected patients with limited disease. Pedicle clamping is often used during resection to decrease intraoperative blood loss; its impact on outcome in patients with colorectal metastases is discussed herein.
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References
Choti MA, Kaloma F, de Oliveira ML et al (2008) Patient variability in intraoperative ultrasonographic characteristics of colorectal liver metastases. Arch Surg 143:29–34
DeOliveira ML, Pawlik TM, Gleisner AL et al (2007) Echogenic appearance of colorectal liver metastases on intraoperative ultrasonography is associated with survival after hepatic resection. J Gastrointest Surg 11:970–6
Bhattacharjya S, Bhattacharjya T, Baber S et al (2004) Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg 91:1361–9
Schmidt J, Strotzer M, Fraunhofer S et al (2000) Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis. World J Surg 24:43–7
Zacherl J, Scheuba C, Imhof M et al (2002) Current value of intraoperative sonography during surgery for hepatic neoplasms. World J Surg 26:550–554
Foroutani A, Garland AM, Berber E et al (2000) Laparoscopic ultrasound vs triphasic computed tomography for detecting liver tumors. Arch Surg 135:933–8
Torzilli G, Del Fabbro D, Palmisano A et al (2005) Contrastenhanced intraoperative ultrasonography during hepatectomies for colorectal cancer liver metastases. J Gastrointest Surg 9:1148–53
Leen E, Ceccotti P, Moug SJ et al (2006) Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection? Ann Surg 243:236–40
Nakano H, Ishida Y, Hatakeyama T et al (2008) Contrastenhanced intraoperative ultrasonography equipped with late Kupffer-phase image obtained by sonazoid in patients with colorectal liver metastases. World J Gastroenterol 14:3207–3211
Mann CD, Neal CP, Metcalfe MS et al (2007) Clinical Risk Score predicts yield of staging laparoscopy in patients with colorectal liver metastases. Br J Surg 94(7):855–9
Jarnagin WR, Conlon K, Bodniewicz J et al (2001) A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases. Cancer 91:1121–28
Torzilli G, Montorsi M, Donadon M et al (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–28
Makuuchi M, Hasegawa H, Yamazaki S et al (1987) Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet 164:68–72
Capussotti L, Ferrero A, Viganò L et al (2006) Hepatic bisegmentectomy 7–8 for a colorectal metastasis. Eur J Surg Oncol 32:469–71
Torzilli G, Montorsi M, Gambetti A et al (2005) Utility of the hooking technique for cases of major hepatectomy. Surg Endosc 19:1156–7
Chouillard E, Cherqui D, Tayar C et al (2003) Anatomical bi-and trisegmentectomies as alternatives to extensive liver resections. Ann Surg 238(1):29–34
Kokudo N, Tada K, Seki M et al (2001) Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 181:153–159
Muratore A, Conti P, Amisano M et al (2005) Bisegmentectomy 7-8 as alternative to more extensive liver resections. J Am Coll Surg 200:224–228
Yamamoto J, Sugihara K, Kosuge T et al (1995) Pathologic support for limited hepatectomy in the treatment of liver metastases from colorectal cancer. Ann Surg 221:74–78
Kokudo N, Miki Y, Sugai S et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840
Zorzi D, Mullen JT, Abdalla EK et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94
Ferrero A, Viganò L, Lo Tesoriere R et al (2009) Bisegmentectomies as alternative to right hepatectomy in the treatment of colorectal liver metastases. Hepatogastroenterology 56:1429–35
KT Nguyen, TC Gamblin, Geller DA (2009) World Review of Laparoscopic Liver Resection-2,804 Patients. Ann Surg 250:831–841
Gayet B, Cavaliere D, Vibert E et al (2007) Totally laparoscopic right hepatectomy Am J Surg 194:685–689
Cherqui D, Husson E, Hammoud R et al (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762
Viganò L, Laurent A, Tayar C et al (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782
Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769
Buell JF, Cherqui D, Geller DA et al (2009) The International Position on Laparoscopic Liver Surgery: The Louisville Statement, 2008 Ann Surg 250:825–30
Cherqui D, Husson E, Hammoud R et al (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762
Gigot JF, Glineur D, Santiago Azagra J et al (2002) Hepatobiliary and Pancreatic Section of the Royal Belgian Society of Surgery and the Belgian Group for Endoscopic Surgery: Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study Ann Surg 236:90–97
Koffron AJ, Auffenberg G, Kung R et al (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392
Gigot JF, Glineur D, Santiago Azagra J et al (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97
Viganò L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg. 16:410–421
Johnstone PAS, Rohde DC, Swartz Se et al (1996) Portsite recurrences after laparoscopic and thoracoscopic procedures in malignacy. J Clin Oncol 14:1950–1956
Poulin EC, Mamazza J, Schlachta C et al (1995) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229:487–492
Bryant R, Laurent A, Tayar C et al (2009) Laparoscopic Liver Resection-Understanding its Role in Current Practice The Henri Mondor Hospital Experience Ann Surg 250:103–111
Hompes D, Aerts R, Penninckx F et al (2007) Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 21:175–180
Vibert E, Perniceni T, Levard H et al (2006) Laparoscopic liver resection. Br J Surg 93:67–72
Robles R, Marin C, Abellan B et al (2008) A new approach to hand-assisted laparoscopic liver surgery. Surg Endosc 22:2357–2364
Castaing D, Vibert E, Ricca L et al (2009) Oncologic Results of Laparoscopic Versus Open Hepatectomy for Colorectal Liver Metastases in Two Specialized Centers. Ann Surg 250: 849–855
Nagorney DM, van Heerden JA, Ilstrup DM et al (1989) Primary hepatic malignancy: surgical management and determinants of survival. Surgery 106:740–749
Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusion on perioperative and lomg-term outcome in patients following hepatic resection for colorectal metastasis. Ann Surg 237:860–869
Yin XY, Lai PBS, Lee JFY et al (2000) Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis. Br J Surg 87:1510–1515
Teoh NC, Farrell GC (2003) Hepatic ischemia reperfusion injury: pathogenic mechanisms and basis for hepatoprotection. J Gastroenterol Hepatol 18:891–902
Abu-Amara M, Gurusamy KS, Glantzounis G et al (2009) Pharmacological interventions for ischaemia reperfusion injury in liver resection surgery performed under vascular control. Cochrane Database Syst Rev (4). Art No CD008154
Muratore A, Ribero D, Ferrero A et al (2003) Prospective randomized study of steroids in the prevention of ischaemic injury during hepatic resection with pedicle clamping. Br J Surg 90:17–22
Gurusamy KS, Kumar Y, Pamecha V et al (2009) Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion. Cochrane Database Syst Rev (1). Art No CD007629
Belghiti J, Noun R, Malafosse R et al (1999) Continuous versus intermittent portal triad clamping for liver resection. Ann Surg 229:369–375
Rahbari NN, Wente MN, Schemmer P et al (2008) Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic resection. Br J Surg 95:424–32
Chouker A, Schachtner T, Schauer R et al (2004) Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial. Br J Anaesth 93:204–211
Capussotti L, Muratore A, Ferrero A et al (2006) Randomized clinical trial of liver resection with and without hepatic pedicle clamping. Br J Surg 93:685–689
Gotoh M, Monden M, Sakon M et al (1994) Hilar lobar vascular occlusion for hepatic resection. J Am Coll Surg 178:6–10
Takayama T, Makuuchi M, Inoue K et al (1998) Selective and unselective clamping in cirrhotic liver. Hepato Gastroenterol 45:376–380
Wu C-C, Yeh D-C, Ho W-H et al (2002) Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients. Arch Surg 137:1369–1376
van der Bilt JD, Kranenburg O, Nijkamp MW et al (2005) Ischemia/reperfusion accelerates the outgrowth of hepatic micrometastases in a highly standardized murine model. Hepatology 42:165–175
van der Bilt JD, Kranenburg O, Borren A et al (2008) Ageing and hepatic steatosis exacerbate ischemia/reperfusion-accelerated outgrowth of colorectal micrometastases. Ann Surg Oncol 15:1392–1398
Buell JF, Koffron A, Yoshida A et al (2000) Is any method of vascular control superior in hepatic resection of metastatic cancers? Longmire clamping, pringle maneuver, and total vascular isolation. Arch Surg 136:569–575
Wong KH, Hamady ZZ, Malik HZ et al (2008) Intermittent Pringle manoeuvre is not associated with adverse long-term prognosis after resection for colorectal liver metastases. Br J Surg 95:985–989
Ferrero A, Russolillo N, Viganò L et al (2010) Does Pringle maneuver affect survival in patients with colorectal liver metastases? WJS in press
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Ferrero, A. (2011). Surgical Strategy. In: Capussotti, L. (eds) Surgical Treatment of Colorectal Liver Metastases. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-1809-9_4
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DOI: https://doi.org/10.1007/978-88-470-1809-9_4
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