Reverse ALPPS on Makuuchi Vein after Combined Systemic and Local Chemotherapy: Compound Existing CRLM Management Techniques to Achieve Surgical Resectability

Abstract

Aims: The main aim of this report to show how incorporation of different techniques in CRLM management has created an opportunity for the resection of locally advanced hepatic tumors formerly considered unresectable. Materials and methods: The current study reports the case of a 38 year-old patient with synchronous CRLM involving all three hepatic veins initially deemed unresectable. The patient developed systemic chemotherapy with molecularly targeted therapy and selective transarterial chemoembolization during 12 months. Subsequent imaging demonstrated a decrease in tumor size with unchanged involvement of the major hepatic veins. However, a right accessory hepatic vein (Makuuchi vein) remained free of disease. Left trisectionectomy by reverse-ALPPS technique with right accessory hepatic vein preservation has been performed. Results: The patient was discharged on POD 14. At the most recent follow-up (23 months), he had presented without evidence of disease. Conclusions: Isolated CRLM where surgical resection is first-line treatment, technical advances and surgical innovations can expand the spectrum of curative interventions. Meantime in patients as was presented only the combination of cross-disciplinary techniques may transform primary irresectability. In this report, the simultaneous utilization of non surgical therapies and advanced surgical skills enabled resection for patients with complex tumors.