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Table of Contents
Intro
Foreword
Foreword
Foreword
Preface
Acknowledgments
Contents
Contributors
Part I: Introduction
1: History of Treatment of Colorectal Liver Metastases
1.1 Introduction
1.2 Early Liver Surgery for Colorectal Liver Metastases
1.2.1 Anatomy
1.2.2 Intraoperative Hemorrhage Control
1.2.3 Tumour Identification
1.3 Surgical Outcomes
1.4 Cytotoxic and Biologic Agents
1.5 Improved Patient Selection Based on Tumour Biology
1.6 Conclusion
References
Part II: Surgery
2: Liver Anatomy
2.1 Introduction
2.2 Functional "Unit" of the Liver
2.2.1 Liver Segment and Terminology
2.2.2 Liver Segmentation and Portal Territory
2.2.3 Intersegmental Plane
2.3 Portal Vein and Hepatic Vein
2.3.1 Symmetrical Configuration of Portal and Venous Ramification Patterns
2.3.2 Variation of Portal Vein and Hepatic Vein
2.3.3 Venous Drainage Map
2.4 Biliary Tract, Hepatic Artery, and Glissonian Pedicle
2.4.1 Biliary Tract
2.4.2 Hepatic Artery
2.4.3 Glissonian Pedicle, Plate Systems, and Laennec's Capsule
2.5 Caudate Lobe (Segment 1)
2.6 Conclusion
References
3: Exposure for Hepatectomy
3.1 Introduction
3.2 Incisions
3.2.1 Midline Laparotomy
3.2.2 J Incision (Makuuchi Incision)
3.3 "Inverted-L" or Modified Makuuchi Incision
3.4 Other Incisions
3.5 Conclusion
References
4: Parenchymal Preservation in the Operative Management of Colorectal Liver Metastases
4.1 Introduction
4.2 Perioperative Outcomes
4.2.1 Perioperative Morbidity
4.2.2 Perioperative Mortality
4.3 Oncologic Outcomes
4.3.1 Margins
4.3.2 Recurrence and Survival
4.3.3 Salvageability
4.4 Special Considerations
4.4.1 Genomic Profiling
4.4.2 Minimally Invasive Surgery
4.5 Conclusion
References.
5: Simulation and Navigation
5.1 Introduction
5.2 Simulation
5.2.1 Three-Dimensional Simulation Software and Virtual Hepatectomy
5.3 Navigation
5.3.1 Intraoperative Ultrasound
5.3.2 Indocyanine Green Fluorescent Imaging
5.3.3 Real-Time Virtual Sonography
5.3.4 Navigation Software and Augmented Reality
5.4 Conclusion
References
6: Advanced Techniques in Multiple Metastases: Fiduciary Markers and Completion Ablation
6.1 Introduction
6.2 Fiducial Marker Placement
6.2.1 Indication
6.2.2 Procedure
6.2.3 Results
6.3 Completion Ablation (Planned Incomplete Resection and Postoperative Completion Ablation)
6.3.1 Definition of Completion Ablation
6.3.2 Indication
6.3.3 Procedure
6.3.4 Results
6.4 Conclusions
References
7: Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: Experience of MD Anderson Cancer Center
7.1 Introduction
7.2 The MD Anderson Cancer Center Approach
7.3 The MD Anderson Cancer Center "Fast-Track" Approach
7.4 Outcomes After Two-Stage Hepatectomy
7.5 Conclusion and Future Aims
References
8: Two-Stage Hepatectomy for Bilobar Colorectal Liver Metastases: Experience of Hôpital Paul-Brousse
8.1 Introduction
8.2 Two-Stage Hepatectomy
8.2.1 Indication
8.2.2 Surgical Procedures of TSH
8.2.3 Chemotherapy
8.2.4 Dropout from the TSH Strategy
8.2.5 Short-Term Outcome
8.2.6 Long-Term Outcome
8.2.7 Surgery for Recurrence
8.2.8 Case Presentation
8.3 Conclusion
References
9: One-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: Experience of the University of Tokyo
9.1 Introduction
9.2 Preoperative Evaluation
9.2.1 Diagnostic Approach
9.2.2 Evaluation of Liver Function and Future Liver Remnant Volume
9.3 Intraoperative Inspection of CLMs.
9.4 Outcomes after One-Stage Hepatectomy
9.5 Future Perspective of One-Stage Hepatectomy
9.6 Conclusion
References
10: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for Colorectal Liver Metastasis
10.1 Introduction
10.2 Evolution of ALPSS as a New Surgical Strategy
10.3 ALPPS for Colorectal Liver Metastases
10.4 When Is ALPPS for CLM Functionally Indicated?
10.4.1 Where Do We Come From? Functional Resectability in the Pre-ALPPS Era
10.4.2 Functional Resectability With ALPPS
10.5 ALPPS for CLM in a Curative Intention
10.6 ALPPS in a Multimodal Treatment of CLM
10.7 Conclusion
References
11: Open Resection Technique
11.1 Introduction
11.2 Anaesthesia
11.3 General Principles
11.4 Access-Incision, Retraction, and Mobilization
11.5 Intra-Operative Ultrasound
11.6 Laparoscopy
11.7 Pringle Manoeuvre
11.8 Liver Dissection/Transection
11.9 Inflow Control
11.10 CUSA
11.11 Intrahepatic Ligation
11.12 Outflow Control
11.13 Sealing the Parenchyma
11.14 Wound Closure
11.15 Special Situations
11.16 Conclusion
References
12: Laparoscopic Liver Resection Technique: The Norwegian Experience
12.1 Introduction
12.2 Laparoscopic Liver Resection for Colorectal Liver Metastases
12.2.1 Selection and Limitations
12.2.2 Surgical Techniques
12.2.2.1 Laparoscopic Nonanatomic Resection (Cauliflower Technique)
12.2.2.2 Left Lateral Sectionectomy
12.2.2.3 Laparoscopic Left Hemihepatectomy
Liver Mobilization
Control of Vascular Inflow
Parenchymal Transection
Outflow Control
12.2.2.4 Laparoscopic Right Hemihepatectomy
Liver Mobilization
Vascular Inflow Control
Parenchymal Transection
Hepatic Venous Outflow Control
12.3 Conclusion/Personal Opinion
References.
13: Laparoscopic Liver Resection Technique: French Experience
13.1 Introduction
13.2 Perioperative and Short-Term Outcomes
13.3 Oncologic and Long-Term Outcomes
13.4 Repeat Liver Resection
13.5 Synchronous Resection of CLM
13.6 Two-Stage Hepatectomy (TSH)
13.7 Associating Liver Partition with Portal Vein Ligation (ALPPS)
13.8 Technical Tips and Tricks
13.8.1 Positioning
13.8.2 Incisions, Exploration, and Exposure
13.8.3 Transection Techniques
13.8.4 Extraction, Drainage, and Closure
13.9 Conclusions
References
14: Laparoscopic Anatomical Liver Resection Technique: The Japanese Experience
14.1 Introduction
14.2 Techniques Based on the Anatomical Landmarks for LALR
14.2.1 Glissonean Approach
14.2.1.1 Anatomical Landmarks for Glissonean Approach
14.2.1.2 Techniques of Glissonean Approach for LAR at Ageo Central General Hospital
Left Hepatectomy
Right Anterior Sectionectomy
Laparoscopic Parenchymal-Sparing Anatomical Liver Resection (Lap-PSAR)
14.2.2 Parenchymal Transection on the Intersegmental Planes
14.2.2.1 Anatomical Landmarks for the Hepatic Veins
Inferior Phrenic Vein (IPV)
Arantius Ligament
14.2.2.2 Approaches for Exposing the HVs
14.2.2.3 Parenchymal Transection under Indocyanine Green (ICG) Fluorescence Image Guidance at Ageo Central General Hospital
14.3 Future Prospects (The Long-Term Advantages of LLR for CRLM)
14.4 Conclusion
References
15: Is There a Place for Robotic Resection?
15.1 Introduction
15.2 Rationale for Minimally Invasive Resection of Colorectal Liver Metastases
15.2.1 Laparoscopic Hepatectomy
15.2.2 Theoretical Advantages of a Robotic Approach
15.3 Learning Curve
15.4 Robotic Hepatectomy Outcomes
15.4.1 Robotic Versus Open Perioperative Outcomes.
15.4.2 Robotic Versus Laparoscopic Perioperative Outcomes
15.4.3 Oncologic Outcomes
15.4.4 Cost
15.5 Limitations of Robotic Hepatectomy
15.6 Robotic Surgery in Practice: Our Approach
15.6.1 Patient Selection for Robotic Hepatectomy
15.6.2 Technical Aspects of Robotic Hepatectomy
15.6.2.1 Positioning and Setup
15.6.2.2 Intraoperative Ultrasound
15.6.2.3 Instrumentation and General Principles
15.6.2.4 Right Hepatectomy
15.6.2.5 Left Hepatectomy
15.6.2.6 Partial Hepatectomy
15.6.2.7 Perioperative Management for Robotic Hepatectomy
15.7 Future Directions
15.8 Conclusion
References
16: Advanced Resection Technique with Vascular Reconstruction
16.1 Introduction
16.2 Rational for Resection and Reconstruction
16.3 Advanced Technique for Resection of CLM
16.3.1 Tumours Located in the Posterosuperior Segments
16.3.2 Resection of Tumours Located at Central Upper Segments with Reconstruction of Hepatic Veins Confluence
16.3.3 Central Lower Tumours with Portal and Biliary Reconstruction
16.4 R1 Resection by Necessity Versus Complex Resection with Vascular Reconstruction
16.5 Oncological Results of Complex Resection with Vascular Reconstruction in CLM
16.6 Conclusion
References
17: Resection Margins
17.1 Introduction
17.2 Resection Margins in Colorectal Liver Metastases
17.2.1 Resection Margins Status as a Predictor of Tumour Recurrence and Overall Survival
17.2.2 Resection Margins and Perioperative Chemotherapy
17.2.3 Resection Margins and Parenchymal-Sparing Hepatectomy
17.2.4 Resection Margins and Minimally Invasive Hepatectomy
17.2.5 Resection Margins and Somatic Gene Mutations
17.2.6 R1 Resection as a Predictor of Recurrence at the Hepatic Resection Margin
17.3 Conclusion
References
18: R1 Vascular Surgery.
Foreword
Foreword
Foreword
Preface
Acknowledgments
Contents
Contributors
Part I: Introduction
1: History of Treatment of Colorectal Liver Metastases
1.1 Introduction
1.2 Early Liver Surgery for Colorectal Liver Metastases
1.2.1 Anatomy
1.2.2 Intraoperative Hemorrhage Control
1.2.3 Tumour Identification
1.3 Surgical Outcomes
1.4 Cytotoxic and Biologic Agents
1.5 Improved Patient Selection Based on Tumour Biology
1.6 Conclusion
References
Part II: Surgery
2: Liver Anatomy
2.1 Introduction
2.2 Functional "Unit" of the Liver
2.2.1 Liver Segment and Terminology
2.2.2 Liver Segmentation and Portal Territory
2.2.3 Intersegmental Plane
2.3 Portal Vein and Hepatic Vein
2.3.1 Symmetrical Configuration of Portal and Venous Ramification Patterns
2.3.2 Variation of Portal Vein and Hepatic Vein
2.3.3 Venous Drainage Map
2.4 Biliary Tract, Hepatic Artery, and Glissonian Pedicle
2.4.1 Biliary Tract
2.4.2 Hepatic Artery
2.4.3 Glissonian Pedicle, Plate Systems, and Laennec's Capsule
2.5 Caudate Lobe (Segment 1)
2.6 Conclusion
References
3: Exposure for Hepatectomy
3.1 Introduction
3.2 Incisions
3.2.1 Midline Laparotomy
3.2.2 J Incision (Makuuchi Incision)
3.3 "Inverted-L" or Modified Makuuchi Incision
3.4 Other Incisions
3.5 Conclusion
References
4: Parenchymal Preservation in the Operative Management of Colorectal Liver Metastases
4.1 Introduction
4.2 Perioperative Outcomes
4.2.1 Perioperative Morbidity
4.2.2 Perioperative Mortality
4.3 Oncologic Outcomes
4.3.1 Margins
4.3.2 Recurrence and Survival
4.3.3 Salvageability
4.4 Special Considerations
4.4.1 Genomic Profiling
4.4.2 Minimally Invasive Surgery
4.5 Conclusion
References.
5: Simulation and Navigation
5.1 Introduction
5.2 Simulation
5.2.1 Three-Dimensional Simulation Software and Virtual Hepatectomy
5.3 Navigation
5.3.1 Intraoperative Ultrasound
5.3.2 Indocyanine Green Fluorescent Imaging
5.3.3 Real-Time Virtual Sonography
5.3.4 Navigation Software and Augmented Reality
5.4 Conclusion
References
6: Advanced Techniques in Multiple Metastases: Fiduciary Markers and Completion Ablation
6.1 Introduction
6.2 Fiducial Marker Placement
6.2.1 Indication
6.2.2 Procedure
6.2.3 Results
6.3 Completion Ablation (Planned Incomplete Resection and Postoperative Completion Ablation)
6.3.1 Definition of Completion Ablation
6.3.2 Indication
6.3.3 Procedure
6.3.4 Results
6.4 Conclusions
References
7: Two-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: Experience of MD Anderson Cancer Center
7.1 Introduction
7.2 The MD Anderson Cancer Center Approach
7.3 The MD Anderson Cancer Center "Fast-Track" Approach
7.4 Outcomes After Two-Stage Hepatectomy
7.5 Conclusion and Future Aims
References
8: Two-Stage Hepatectomy for Bilobar Colorectal Liver Metastases: Experience of Hôpital Paul-Brousse
8.1 Introduction
8.2 Two-Stage Hepatectomy
8.2.1 Indication
8.2.2 Surgical Procedures of TSH
8.2.3 Chemotherapy
8.2.4 Dropout from the TSH Strategy
8.2.5 Short-Term Outcome
8.2.6 Long-Term Outcome
8.2.7 Surgery for Recurrence
8.2.8 Case Presentation
8.3 Conclusion
References
9: One-Stage Hepatectomy for Bilateral Colorectal Liver Metastases: Experience of the University of Tokyo
9.1 Introduction
9.2 Preoperative Evaluation
9.2.1 Diagnostic Approach
9.2.2 Evaluation of Liver Function and Future Liver Remnant Volume
9.3 Intraoperative Inspection of CLMs.
9.4 Outcomes after One-Stage Hepatectomy
9.5 Future Perspective of One-Stage Hepatectomy
9.6 Conclusion
References
10: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for Colorectal Liver Metastasis
10.1 Introduction
10.2 Evolution of ALPSS as a New Surgical Strategy
10.3 ALPPS for Colorectal Liver Metastases
10.4 When Is ALPPS for CLM Functionally Indicated?
10.4.1 Where Do We Come From? Functional Resectability in the Pre-ALPPS Era
10.4.2 Functional Resectability With ALPPS
10.5 ALPPS for CLM in a Curative Intention
10.6 ALPPS in a Multimodal Treatment of CLM
10.7 Conclusion
References
11: Open Resection Technique
11.1 Introduction
11.2 Anaesthesia
11.3 General Principles
11.4 Access-Incision, Retraction, and Mobilization
11.5 Intra-Operative Ultrasound
11.6 Laparoscopy
11.7 Pringle Manoeuvre
11.8 Liver Dissection/Transection
11.9 Inflow Control
11.10 CUSA
11.11 Intrahepatic Ligation
11.12 Outflow Control
11.13 Sealing the Parenchyma
11.14 Wound Closure
11.15 Special Situations
11.16 Conclusion
References
12: Laparoscopic Liver Resection Technique: The Norwegian Experience
12.1 Introduction
12.2 Laparoscopic Liver Resection for Colorectal Liver Metastases
12.2.1 Selection and Limitations
12.2.2 Surgical Techniques
12.2.2.1 Laparoscopic Nonanatomic Resection (Cauliflower Technique)
12.2.2.2 Left Lateral Sectionectomy
12.2.2.3 Laparoscopic Left Hemihepatectomy
Liver Mobilization
Control of Vascular Inflow
Parenchymal Transection
Outflow Control
12.2.2.4 Laparoscopic Right Hemihepatectomy
Liver Mobilization
Vascular Inflow Control
Parenchymal Transection
Hepatic Venous Outflow Control
12.3 Conclusion/Personal Opinion
References.
13: Laparoscopic Liver Resection Technique: French Experience
13.1 Introduction
13.2 Perioperative and Short-Term Outcomes
13.3 Oncologic and Long-Term Outcomes
13.4 Repeat Liver Resection
13.5 Synchronous Resection of CLM
13.6 Two-Stage Hepatectomy (TSH)
13.7 Associating Liver Partition with Portal Vein Ligation (ALPPS)
13.8 Technical Tips and Tricks
13.8.1 Positioning
13.8.2 Incisions, Exploration, and Exposure
13.8.3 Transection Techniques
13.8.4 Extraction, Drainage, and Closure
13.9 Conclusions
References
14: Laparoscopic Anatomical Liver Resection Technique: The Japanese Experience
14.1 Introduction
14.2 Techniques Based on the Anatomical Landmarks for LALR
14.2.1 Glissonean Approach
14.2.1.1 Anatomical Landmarks for Glissonean Approach
14.2.1.2 Techniques of Glissonean Approach for LAR at Ageo Central General Hospital
Left Hepatectomy
Right Anterior Sectionectomy
Laparoscopic Parenchymal-Sparing Anatomical Liver Resection (Lap-PSAR)
14.2.2 Parenchymal Transection on the Intersegmental Planes
14.2.2.1 Anatomical Landmarks for the Hepatic Veins
Inferior Phrenic Vein (IPV)
Arantius Ligament
14.2.2.2 Approaches for Exposing the HVs
14.2.2.3 Parenchymal Transection under Indocyanine Green (ICG) Fluorescence Image Guidance at Ageo Central General Hospital
14.3 Future Prospects (The Long-Term Advantages of LLR for CRLM)
14.4 Conclusion
References
15: Is There a Place for Robotic Resection?
15.1 Introduction
15.2 Rationale for Minimally Invasive Resection of Colorectal Liver Metastases
15.2.1 Laparoscopic Hepatectomy
15.2.2 Theoretical Advantages of a Robotic Approach
15.3 Learning Curve
15.4 Robotic Hepatectomy Outcomes
15.4.1 Robotic Versus Open Perioperative Outcomes.
15.4.2 Robotic Versus Laparoscopic Perioperative Outcomes
15.4.3 Oncologic Outcomes
15.4.4 Cost
15.5 Limitations of Robotic Hepatectomy
15.6 Robotic Surgery in Practice: Our Approach
15.6.1 Patient Selection for Robotic Hepatectomy
15.6.2 Technical Aspects of Robotic Hepatectomy
15.6.2.1 Positioning and Setup
15.6.2.2 Intraoperative Ultrasound
15.6.2.3 Instrumentation and General Principles
15.6.2.4 Right Hepatectomy
15.6.2.5 Left Hepatectomy
15.6.2.6 Partial Hepatectomy
15.6.2.7 Perioperative Management for Robotic Hepatectomy
15.7 Future Directions
15.8 Conclusion
References
16: Advanced Resection Technique with Vascular Reconstruction
16.1 Introduction
16.2 Rational for Resection and Reconstruction
16.3 Advanced Technique for Resection of CLM
16.3.1 Tumours Located in the Posterosuperior Segments
16.3.2 Resection of Tumours Located at Central Upper Segments with Reconstruction of Hepatic Veins Confluence
16.3.3 Central Lower Tumours with Portal and Biliary Reconstruction
16.4 R1 Resection by Necessity Versus Complex Resection with Vascular Reconstruction
16.5 Oncological Results of Complex Resection with Vascular Reconstruction in CLM
16.6 Conclusion
References
17: Resection Margins
17.1 Introduction
17.2 Resection Margins in Colorectal Liver Metastases
17.2.1 Resection Margins Status as a Predictor of Tumour Recurrence and Overall Survival
17.2.2 Resection Margins and Perioperative Chemotherapy
17.2.3 Resection Margins and Parenchymal-Sparing Hepatectomy
17.2.4 Resection Margins and Minimally Invasive Hepatectomy
17.2.5 Resection Margins and Somatic Gene Mutations
17.2.6 R1 Resection as a Predictor of Recurrence at the Hepatic Resection Margin
17.3 Conclusion
References
18: R1 Vascular Surgery.