levoleucovorin and Hypertrophy

For colorectal liver metastasis (CRLM) patients, hepatic resection is currently the sole cure offering the chance of long-term survival. Tumor shrinkage and planned liver remnant hypertrophy are the two key strategies for conversion of initially unresectable CRLM. First conducted in 2012, associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows rapid liver growth. As a means to induce hypertrophy, portal vein embolization (PVE) has been widely applied before extending hepatectomy. Recently, Peng et al. present a new approach of terminal branches portal vein embolization (TBPVE), offering an efficient way to amplify FLR and making chances for surgery in 2 weeks.. We reported a 61-year-old woman with synchronous hepatic metastasized carcinoma of the colon sigmoideum underwent TBPVE after 6 cycles of neoadjuvant therapy in order to perform a planned right trisectionectomy. Rapid liver remnant hypertrophy and remarkable tumor shrinkage were achieved, and laparoscopic sigmoidectomy and right trisectionectomy were successfully performed. The postsurgical course was uneventful and 7 months of recurrence-free survival have been witnessed.. The dual tactics of tumor shrinkage and planned rapid liver remnant hypertrophy will make concerted efforts to further increase the clinical candidacy for curative resection, which are valuable for further investigation.

Topics: Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Carcinoembryonic Antigen; Carcinoma; Colon, Sigmoid; Colonoscopy; Colorectal Neoplasms; Embolization, Therapeutic; Female; Fluorouracil; Hepatectomy; Humans; Hypertrophy; Laparoscopy; Leucovorin; Ligation; Liver; Liver Neoplasms; Liver Regeneration; Magnetic Resonance Imaging; Middle Aged; Neoadjuvant Therapy; Portal Vein; Prognosis; Treatment Outcome; Vascular Surgical Procedures

This prospective study evaluated the effect of bevacizumab on the hypertrophy of the future liver remnant (FLR) after portal vein occlusion (PVO) before major hepatectomy for colorectal liver metastases.. Twenty-seven patients with colorectal liver metastases treated with preoperative FOLFOX/FOLFIRI chemotherapy regimen since 2002 were evaluated for the degree of hypertrophy of the FLR after right PVO. The results were compared with a similar group of 13 patients treated since 2006 with a chemotherapeutic regimen including bevacizumab and PVO. The FLR was measured by volumetric computed tomography 4 weeks before and after PVO.. Before PVO, the FLR volumes were similar in the 13 patients who received bevacizumab (bev+) (mean +/- standard deviation, 497 +/- 136 cm(3)) and the 27 patients who did not receive bevacizumab (bev-) (511 +/- 222 cm(3), P = NS). After PVO, the increase in the FLR volume was significantly lower in the bev+ group (561 +/- 171 cm(3)) compared with the bev- group (667 +/- 213 cm(3), P < .031). In the bev+ group, patients who had received six or more cycles and were > or =60 years old experienced far lower hypertrophy. A right hepatectomy was performed in 29 patients (72%) without mortality and no clinically important differences in morbidity.. Bevacizumab may impair hypertrophy of the FLR after PVO in preparation for major hepatectomy particularly, in patients aged > or =60 years and those who receive six or more cycles of bevacizumab, suggesting that major liver resection should be considered with caution in patients who have received bevacizumab.

Topics: Adult; Aged; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Colorectal Neoplasms; Female; Fluorouracil; Hepatectomy; Humans; Hypertrophy; Leucovorin; Ligation; Liver; Liver Circulation; Liver Neoplasms; Liver Regeneration; Male; Middle Aged; Organoplatinum Compounds; Portal Vein; Preoperative Care; Prospective Studies; Young Adult