Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Protocollo RAPID per trapianto di fegato in due tempi per metastasi da tumore del colon

Il gruppo dell’Università di Oslo, Norvegia, pubblica il protocollo RAPID (Resection And Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy).

Lo studio si propone di verificare la fattibilità nella combinazione del trapianto dei segmenti 2 e 3 del fegato e dell’emi-epatectomia in due tempi, allo scopo di ottenere nelle 4 settimane successive al trapianto l’epatectomia totale.

L’indicazione è posta in pazienti portatori di metastasi epatiche da tumore colo-rettale non resecabili. La presenza di 1 – 3 metastasi polmonari di diametro superiore ai 15 millimetri non era un criterio di esclusione.

La referenza bibliografica per questo evento è:

 

 

Pål-Dag Line, Morten Hagness, Audun Elnaes Berstad, Aksel Foss, Svein Dueland: A novel concept for partial liver transplantation in nonresectable colorectal liver metastases: The RAPID concept. In: Annals of Surgery, vol. 262, no. 1, pp. e5 – e9, 2015, ISSN: 00034932, (Cited by: 104).

Abstract

Objective: Selected patients with nonresectable colorectal liver metastases benefit from liver transplantation and have acceptable 5-year survival rates. However, allocating full-sized grafts to this group of patients is difficult due to the scarcity of grafts. This could be improved by utilizing small partial grafts,which mandates effective strategies to overcome the problems regarding insufficient functional liver mass. Methods: We have developed a protocol incorporating previously reported experiences from living donor transplantation and recent developments in liver surgery, facilitating transplantation of very small liver grafts. At the time of transplantation, segments 1 to 3 are resected in the recipient and orthotopically replaced by a segment 2 to 3 allograft. Portal inflowismodulated by redirecting the portal flow to the graft with concomitant focus on keeping the portal vein pressure below 20 mm Hg. A second-stage hepatectomy is performed as soon as the graft has regenerated to a sufficient volume. Results: Agraftweighing 330 gwas transplanted to a 50-year-old manweighing 92 kg, and the portal vein to the right remnant liver was closed. The volume of the liver graft was doubled 2 weeks after the first procedure, and it increased further after the second procedure, with extended right hepatectomy performed at day 23 after transplantation. There were no signs of liver failure or small-for-size syndrome. Conclusions: The current protocol and ongoing study could represent a possible strategy to increase the availability of liver transplantation to patients with nonresectable liver tumors such as hepatocellular carcinoma and colorectal liver metastases. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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