Dept. of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany.
Dept. of General, Visceral and Vascular Surgery, University Hospital Jena, Germany.
Int J Surg. 2020 Oct;82S:93-96. doi: 10.1016/j.ijsu.2020.03.078. Epub 2020 Apr 14.
Liver transplantation for colorectal cancer has regained renewed interest with reported good overall survival in selected patients. The scarcity of grafts is a major obstacle to wider implementation and exploration of this field of transplant oncology. The use of small segmental auxiliary grafts from deceased or living donors might be one way to expand the donor pool with minimal negative impact on the waiting list for deceased donor transplantation and minimal risk for the donor in case of living donor liver transplantation. This review provides an insight into the physiological background for this technique and summarizes technical and surgical considerations and the experiences with this novel concept. Although the international experience still is very limited, the short term outcome could suggest that this is technically feasible. There is not sufficient data to assess long term oncological outcome. The RAPID concept (i.e. resection and partial liver segment 2-3 transplantation with delayed total hepatectomy) is still an experimental surgical procedure and should be reserved for prospective clinical trials. Herein, we describe the main technical issues of RAPID procedure from deceased and from living donor as well and report preliminary results of the first cases performed worldwide.
结直肠癌的肝移植再次受到关注，有报道称在选定的患者中总体生存率良好。供体器官的稀缺是广泛实施和探索移植肿瘤学这一领域的主要障碍。使用来自已故或活体供体的小的节段辅助移植物可能是一种方法，可以在不对已故供体移植等待名单产生负面影响和对活体供体肝移植供体产生最小风险的情况下，扩大供体库。这篇综述深入探讨了该技术的生理学背景，并总结了该技术的技术和手术注意事项，以及该新概念的经验。尽管国际经验仍然非常有限，但短期结果可能表明这在技术上是可行的。目前还没有足够的数据来评估长期肿瘤学结果。RAPID 概念（即切除和部分肝段 2-3 移植，然后延迟全肝切除术）仍然是一种实验性手术程序，应保留用于前瞻性临床试验。在此，我们描述了来自已故供体和活体供体的 RAPID 手术的主要技术问题，并报告了全球首例病例的初步结果。
