Liver resection extended rebound after bipartition of the in situ liver, followed by implantation of artificial liver support
HM University Sanchinarro (HMS) recently conducted an extended liver resection, after conducting a bipartition of in situ liver, which followed the introduction of a system of artificial liver support. A complex approach carried out "for the first time in Spain" through "modern and integrated way of working between services General and Digestive Surgery, Anesthesia, Intensive Care and Oncology at our hospital, with the implementation of surgical techniques medical and therapeutic supports more advanced treatments are "in the words of Dr. Emilio Vicente and Dra. Yolanda Quijano, director and co-director, respectively, of the Department of General Surgery and Digestive HMS.
The extended liver resection after embodiment, a bipartition of the liver in situ "represents a new strategy for greater radicalism in the surgical treatment of liver metastases," says Dr. Vincent.
For this purpose, they conducted two surgical procedures at different times. In the first full bipartition liver was performed and the right portal vein was ligated in an attempt to produce a compensatory hypertrophy of the remnant liver. In the second previously dissected and sectioned vasculobiliares pedicle resection of the liver area affected by metastatic disease was made.
This technique -realizada by Drs. Duran, Marcello Diaz, Fabra and Puga, the same service that Dr. Vincent and Dr. Quijano.; and Roman, Corbacho, Carbajo, Alvarez and Rodriguez, the service allows rescue doctors anesthetized for surgery patients who otherwise might be considered unresectable; Two-time realization minimizes surgical risk with respect to the conventional technique, and patient recovery is usually faster, allowing start the post-operative chemotherapy more early.
The use of such media for post-operative situations of failure after liver resection is less than 10% of the usual case mix, so this case, by Drs. Cordoba, Martinez Morato and Grando, HMS ICU, "represents the first use of this system in a private hospital," says Dr. Vincent.
A massive bilobar metastatic disease patient is individualized chemotherapy applied, adapted to the molecular characteristics of the tumor. After treatment, performed by Drs. Hidalgo, Cubillo Rodriguez and Alvarez, the CIOCC, and after he underwent surgery, it was found in the resected liver (70% of total volume) the absence of disease.
The pathologic complete response is exceptional and "a clear manifestation of onco logical that drugs in cancer treatment should be directed to different biomarkers, avoiding uniformity in therapeutic regimens that are not always effective."