Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.
Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.
Ann Surg. 2019 Aug;270(2):327-332. doi: 10.1097/SLA.0000000000002861.
to report the first case of resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (RAPID) from living donor in a patient affected of irresectable colorectal liver metastases (i-CRLM) BACKGROUND:: A renaissance of liver transplantation (LT) for i-CRLM has been recently observed. The Norwegian SECA trial demonstrated a 5-year overall survival rate of approximately 60%, notwithstanding early tumor recurrence. The RAPID technique was recently introduced as alternative to whole deceased donor LT, but it is limited by poor availability of splittable organs and many organisational aspects. In this context left lateral living donor LT may be the ideal solution.
Report about the technique and results of living donor RAPID procedure.
A 49 years old woman affected with i-CRLM from adenocarcinoma of right colon, underwent a left hepatectomy with ligation of right portal vein maintaining the right hepatic artery patent. Subsequently, the left lateral lobe from her son was implanted as auxiliary partial orthotopic LT. Two weeks later completion of hepatectomy was performed.
The donor postoperative course was uneventful. The recipient developed postoperatively a slight small for size syndrome which spontaneously resolved. No graft dysfunction and no rejection were observed. At POM 5 micrometastases occurred in bones and lungs, which were treated with radiotherapy and chemotherapy, respectively. Almost 2 years later the patient is alive, in good general condition, although slight progression of bone and lung metastases.
LT poses a valid treatment option for i-CRLM. In times of organ paucity, "living donor-RAPID" procedure may represent a paradigm shift in the management of i-CRLM.
报告首例来自不可切除结直肠癌肝转移（i-CRLM）患者的活体供肝切除和部分肝段 2-3 移植联合延迟全肝切除术（RAPID）。背景：最近观察到肝移植（LT）治疗 i-CRLM 出现复兴。挪威 SECA 试验证明，即使早期肿瘤复发，5 年总生存率也约为 60%。最近，RAPID 技术被引入作为全尸肝 LT 的替代方法，但它受到可分割器官供应不足和许多组织方面的限制。在这种情况下，左外侧活体供肝 LT 可能是理想的解决方案。
报告活体供体 RAPID 手术的技术和结果。
一名 49 岁女性，患有右结肠癌引起的 i-CRLM，接受了左肝切除术，同时结扎右门静脉以保持右肝动脉通畅。随后，她儿子的左外叶被植入作为辅助部分原位 LT。两周后完成了全肝切除术。
供体术后过程平稳。受者术后出现轻微的小肝综合征，自发缓解。未观察到移植物功能障碍和排斥反应。术后 5 个月，患者出现骨骼和肺部微转移，分别接受放疗和化疗。大约 2 年后，患者仍然存活，一般情况良好，尽管骨骼和肺部转移略有进展。
LT 是 i-CRLM 的有效治疗选择。在器官匮乏时期，“活体供体-RAPID”手术可能代表 i-CRLM 管理的范式转变。
