Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy (LAPS)

One of the limiting factors in the execution of a liver resection, in particular an extended liver resection, it's represented by the future remnant liver (FRL) after hepatic surgery. In cases of normal organ function an FRL of 25% is considered sufficient. In case of impaired hepatic function or a history of chemotherapy, it is considered safe if at least of 40%. Many strategies have been developed and proposed to increase the resectability in patients undergoing major liver resections. One of these is a new two-stage technique proposed recently by a group of German surgeons. This approach consists in the ligation of the right portal vein associated with resection of the liver along the falciform ligament (step 1). Step 2, after a period of 9 days (median - 5-25 days), after a volumetric CT to ensure an adeguate hypertrophy of the left lateral lobe due to the combination of right portal occlusion and segment 4 devascularization, the patient undergo a right trisectionectomy. The hypertrophy of the left lateral lobe is shown to be of 74%, higher than any other techniques of ligation or portal embolizatiol proposed in the literature. On the basis of the clinical experiences reported the investigators designed a new protocol of two-stage hepatic resection for the treatment of primary or secondary tumors of the right lobe. Step1: laparoscopic radio frequency / microwave ablation of the future transection plane between segment 4 and left lateral lobe and surgical ligation or embolization of the right portal vein. The ablation has the purpose to devascularize the segment 4 and has the same significance of the resection of the liver along the falciform ligament described by the Regensburg group. Step2: After a period of time of 9 ± 2 days, following a volumetric CT showing an adequate liver volume gain (ratio FRL / patient body weight\> 0.5), the patient undergo the second-stage surgery: laparoscopic/ laparotomic right trisectionectomy.

Sex

All

Minimum age

18 Years

Maximum age

70 Years

Inclusion Criteria:

* Patients aged between 18 and 70 years (M and F)
* Liver tumors that interests the right hepatic lobe (segments 4,5,6,7,8) with possible involvement of the caudate lobe (segment 1) or bilobar disease with less than 3 lesions in the left lateral lobe without vascular involvement and amenable to surgically resectable or ablation in the Step1.
* Absence of extrahepatic disease
* Normal hepatic function (total bilirubin \<3 mg / dL)
* Performance status: ECOG 0
* In case of liver cirrhosis MELD score \<9
* Patients without prior chemotherapy or with previous chemotherapy but with response disease
* Patients who give their consent to the intervention

Exclusion Criteria:

* CT Evidence of involvement of the major vessels in the future remnant liver
* Presence of more than 3 nodules in the left lateral lobe
* Presence of extrahepatic disease
* Severe hepatic impairment
* Age\> 70 years
* Previous liver surgery (prior liver resections)
* Patient receiving chemotherapy with documented disease progression

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