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Shahrestani S, Mason E, Jayasekara J, Gall T, Sirimanna P, Mittal A, Samra J. Embryology to the rescue: restoration of hepatic blood flow via the remnant umbilical vein following iatrogenic bilateral portal vein embolization. ANZ J Surg 2023; 93:2760-2761. [PMID: 37480177 DOI: 10.1111/ans.18617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Sara Shahrestani
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Mason
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jayani Jayasekara
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Tamara Gall
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Pram Sirimanna
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jaswinder Samra
- Department of Upper GI Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Shah JL, Zendejas-Ruiz IR, Thornton LM, Geller BS, Grajo JR, Collinsworth A, George TJ, Toskich B. Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation. J Gastrointest Oncol 2017; 8:E43-E51. [PMID: 28736649 DOI: 10.21037/jgo.2017.01.26] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Colorectal cancer patients have a high incidence of liver metastasis (ml-CRC). Surgical resection is the gold standard for treatment of hepatic metastasis but only a small percent of patients are traditional candidates based on disease extent and adequate size of the future liver remnant (FLR). Interventions such as portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are performed to increase FLR for operative conversion. Limitations to PVE include intrahepatic disease progression, portal vascular invasion, and utilization with concurrent chemotherapy. ALPPS is associated with a high morbidly and mortality. Radiation lobectomy (RL) with yttrium-90 (Y-90) delivers transarterial ablative brachytherapy to the future hepatectomy site which generates FLR hypertrophy similar or greater than PVE. Early results indicate that RL is safe, effective, and may offer unique benefits by providing cytoreduction of hepatic metastases which extends FLR hypertrophy time and allows FLR surveillance to gauge disease biology. A retrospective analysis of four patients with ml-CRC treated with RL prior to hepatectomy was performed to evaluate initial safety, efficacy, FLR hypertrophy, and radiopathologic correlation. Adverse events after RL and hepatectomy were evaluated. Imaging findings were analyzed for efficacy defined as FLR hypertrophy and disease control. Radiopathologic correlation was performed after histologic analysis. RL was well tolerated without major adverse events or hepatic decompensation. FLR hypertrophy ranged from 24.9% to 119% at mean follow-up of three months. The majority of complications were related to surgical instrumentation of the FLR due to upstaging at time of surgery. Hepatectomy specimen histology demonstrated complete pathologic response in 50% of patients, 50% radiopathologic concordance rate, and no significant hepatic fibrosis. Initial experience with neoadjuvant RL for ml-CRC is safe and provides both durable disease control and FLR hypertrophy with concurrent chemotherapy. A 50% complete pathologic response rate raises the possibility of definitive chemoradiation in poor surgical candidates. Prospective investigation is required.
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Affiliation(s)
- Jehan L Shah
- Department of Radiology, University of Florida, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | | | - Linday M Thornton
- Department of Radiology, University of Florida, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | - Brian S Geller
- Department of Radiology, University of Florida, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | - Amy Collinsworth
- Department of Pathology, University of Florida, Immunology and Laboratory Medicine, Gainesville, FL 32608, USA
| | - Thomas J George
- Department of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Beau Toskich
- Department of Radiology, University of Florida, Post Office Box 100374, Gainesville, Florida 32610-0374, USA.,Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA
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Jacobs MA, Lanciault C, Weinstein S. Incidental biliary adenofibroma with dysplastic features. BJR Case Rep 2015; 1:20150100. [PMID: 30363187 PMCID: PMC6159130 DOI: 10.1259/bjrcr.20150100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/27/2015] [Accepted: 06/03/2015] [Indexed: 01/01/2023] Open
Abstract
We present a case of an incidentally detected cystic liver mass on CT scan, with histology showing biliary epithelium embedded in fibrous stroma and dysplastic features, consistent with an adenofibroma. This is only the third case described in the literature with malignant histology and the first case with angiographic imaging and subsequent management with preoperative embolization prior to surgical resection. We discuss the differential of the imaging findings and the features of this rare entity. Because of the risk of malignant transformation, consideration of this tumour is important to ensure early detection and ultimately resection for improved survival.
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Affiliation(s)
| | - C Lanciault
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - S Weinstein
- Address correspondence to: Dr Stefanie Weinstein E-mail:
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Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010; 12:139-46. [PMID: 20495659 PMCID: PMC2826673 DOI: 10.1111/j.1477-2574.2009.00151.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/08/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver failure has remained a major cause of mortality after hepatectomy, but it is difficult to predict preoperatively. This study describes the introduction into clinical practice of the new LiMAx test and provides an algorithm for its use in the clinical management of hepatic tumours. METHODS Patients with hepatic tumours and indications for hepatectomy were investigated perioperatively with the LiMAx test. In one patient, analysis of liver volume was carried out with preoperative three-dimensional virtual resection. RESULTS A total of 329 patients with hepatic tumours were evaluated for hepatectomy. Blinded preoperative LiMAx values were significantly higher before resection (n= 139; mean 351 microg/kg/h, range 285-451 microg/kg/h) than before refusal (n= 29; mean 299 microg/kg/h, range 223-376 microg/kg/h; P= 0.009). In-hospital mortality rates were 38.1% (8/21 patients), 10.5% (2/19 patients) and 1.0% (1/99 patients) for postoperative LiMAx of <80 microg/kg/h, 80-100 microg/kg/h and >100 microg/kg/h, respectively (P < 0.0001). A decision tree was developed to avoid critical values and its prospective preoperative application revealed a reduction in mortality from 9.4% to 3.4% (P= 0.019). DISCUSSION The LiMAx test can validly determine liver function capacity and is feasible in every clinical situation. Combination with virtual resection could enable the calculation of residual liver function. The LiMAx decision tree algorithm for hepatectomy might significantly improve preoperative evaluation and postoperative outcome in liver surgery.
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Affiliation(s)
- Martin Stockmann
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Johan F Lock
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Maciej Malinowski
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | | | - Daniel Seehofer
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
| | - Peter Neuhaus
- Departments of General, Visceral and Transplantation SurgeryBerlin, Germany
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