Titlebook: Extreme Hepatic Surgery and Other Strategies; Increasing Resectabi Eduardo de Santiba?es,Victoria Ardiles,Martin de S Book 2017 Springer In

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Vascular Control in Major Hepatic Resectionst required for every liver resection, a profound knowledge of vascular control is required for the modern liver surgeon. Intraoperative blood loss remains one of the major risk factors for postoperative morbidity and mortality, and therefore vascular control plays a major role in performing safe liver resection for colorectal liver metastases.

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Liver Surgical Anatomyand three segments; and a dorsal, retroportal segment 1; separated by the main hepatic veins and the portal bifurcation, offers a consensual . description that is very useful to localize liver lesion and the main types of liver resections. Alternative representations, and in particular customized ra

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Resectability Assessment with Diagnostic Imagingan survival of 6–8 months in patients not receiving any treatment. The main treatment for CLM?is surgical resection, although in about two-third of the patients, recurrence of the tumor occurs. The criteria for resectable CLM?have been broadened over the past decades, leading to more CLM being consi

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Preoperative Evaluation of Liver Function the last decade, resulting in an increased rate of complex and extended liver resections. Postoperative outcomes mainly depend on the size and quality of the future liver?remnant (FLR). Liver resection, when performed in the absence of sufficient FLR, inevitably leads to post-resectional liver fail

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Choosing the Best Strategytherapeutic and adjunct techniques to surgery has contributed greatly to improve resectability rates and outcomes. As a consequence, patients with advanced CLM are living longer than they did previously due to these major advances in treatment. The surgical strategy should be tailored according to t

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Conversion and Neoadjuvant Therapiesgical technical advances, optimal systemic chemotherapy management, and increased awareness among all healthcare professionals of the benefits of screening, are responsible for the continuous growth in the number of patients eligible for curative surgery of CLMs. Many patients who were historically

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Portal Vein Embolizationficient future liver remnant (FLR). PVE is recommended when FLR <20% in normal liver, FLR <30% in liver pretreated with more than 3 months of chemotherapy, and FLR <40% in the cirrhotic liver. Embolization of the right or left portal vein branch causes atrophy of the ipsilateral liver and hypertroph

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Intra-Arterial Chemotherapye and unresectable liver metastases, hepatic arterial infusion (HAI) chemotherapy with floxuridine has been shown to be an effective and safe method of treating patients with CLM. As an adjuvant therapy, HAI is associated with markedly improved hepatic progression-free survival and improved overall

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Radioembolizationsation. Radioembolization, an interventional radiology liver-directed therapy with Yttrium-90 microspheres, is a proven treatment to slow disease progression and improve survival in patients with colorectal cancer liver metastases. The antitumor effect is related to radiation rather than embolizatio