BookEduardo de Santibañes, Victoria Ardiles, Fernando A. Alvarez, Virginia Cano Busnelli, Martin de Santibañes, editors.
Summary: This book describes the diagnoses; staging and management of patients with colorectal liver metastases initially considered unresectable and portrays the different strategies to increase resectability along with their tactics and tricks. Colorectal carcinoma is the third most commonly diagnosed cancer in the world and according to recent cancer statistics around 1.23 million patients are diagnosed each year. Of these patients, approximately 50% will develop liver metastases during the course of their disease and around 15-25% are found to have stage IV disease at diagnosis. Liver resection has been recognized as the treatment of choice for these patients, offering overall 5-year survival rates of up to 50-60% and the only hope for cure. However, at diagnosis only 10-20% of these patients are possibly amenable to surgical resection with curative intent. The possibility to achieve an R0 resection is many times limited by the amount and quality of the future liver remnant (FLR), being posthepatectomy liver failure (PHLF) the most feared and severe complication after major liver resections. With the years, diverse strategies have been developed with the intention to increase resectability by increasing the future liver remnant and/or reducing tumor size, e.g. ALPPS. Along with these techniques, associated surgeries are developed including multivisceral resections, which broadens even more the resectability for patients.
Contents:
Part I Introduction. 1. Introduction
2. Liver surgical anatomy
II. Global patient evaluation and oncological assessment
3. Resectability assessment with diagnostic imaging
4. Liver function evaluation before extreme liver surgery
5. Imaging-based preoperative planning
6. Choosing the best strategy. Multidisciplinary evaluation
III
Non-operative multimodal therapies
7. Conversion and neoadjuvant therapies
8. Portal embolization
9. Intraarterial chemotherapy
10. Radioembolization
IV. Surgical strategies
11. Anesthetics management
12. Intraoperative evaluation of resectability
13. Vascular control in major hepatic resections
14. Two-stage liver surgery
15. Two-stage liver surgery with portal occlusion
16 ALPPS
17. Parenchymal-sparing liver resections
18. Combined vascular resections
19. Ex-vivo liver surgery
20. Liver transplant
21. The roll of laparoscopy in advanced liver disease
V. Management of concomitant extrahepatic disease
22. Pulmonary metastases
23. Nodal involvement
24. Peritoneal disease
25. Adjacent organs invasion. Multivisceral resections
VI. Postoperative complications and their management
26. Complications of hepatic resections
VII. Palliative care
27. Palliative care in patients with extensive disease.