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Lendoire M, Maki H, Haddad A, Jain AJ, Vauthey JN. Liver Anatomy 2.0 Quiz: Test Your Knowledge. J Gastrointest Surg 2023; 27:3045-3068. [PMID: 37803180 DOI: 10.1007/s11605-023-05778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/01/2023] [Indexed: 10/08/2023]
Abstract
The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.
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Affiliation(s)
- Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
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Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP, Kemeny N, Porter G, Fields RC, Pingpank J, Dixon E, Wei A, Cleary S, Zogopoulos G, Dey C, D'Angelica M, Fong Y, Dowden S, Ko YJ. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. ACTA ACUST UNITED AC 2014; 21:e129-36. [PMID: 24523610 DOI: 10.3747/co.21.1577] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used. We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements: haip chemotherapy should be given in combination with systemic chemotherapy.haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases. These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip.
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Affiliation(s)
- P J Karanicolas
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - P Metrakos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - K Chan
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T Asmis
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - E Chen
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T P Kingham
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - N Kemeny
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - G Porter
- Nova Scotia: Department of Surgery (Porter), Dalhousie University, Halifax
| | - R C Fields
- Missouri: Department of Surgery (Fields), Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis
| | - J Pingpank
- Pennsylvania: Department of Surgery (Pingpank), University of Pittsburgh, Pittsburgh
| | - E Dixon
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - A Wei
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - S Cleary
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - G Zogopoulos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - C Dey
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - M D'Angelica
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - Y Fong
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Dowden
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - Y J Ko
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
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Sofocleous CT, Schubert J, Kemeny N, Covey AM, Brody LA, Getrajdman GI, Thornton R, Winston C, Brown KT. Arterial Embolization for Salvage of Hepatic Artery Infusion Pumps. J Vasc Interv Radiol 2006; 17:801-6. [PMID: 16687745 DOI: 10.1097/01.rvi.0000217937.81939.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hepatic artery infusion pumps (HAIPs) ideally provide for homogenous perfusion of the liver with chemotherapeutic agents. Perfusion of extrahepatic organs or asymmetric liver perfusion (ie, "misperfusion") is diagnosed by nuclear scintigraphy and precludes the use of HAIPs. The purpose of this study is to report experience in salvaging HAIPs with arterial embolization. MATERIALS AND METHODS A single-center HAIP database was retrospectively reviewed for cases from 1999 to 2005 to identify patients who underwent angiography to treat misperfusion documented by nuclear scintigraphy. Patient demographics, nuclear scintigraphic findings before and after embolization, angiographic findings, embolization variables, and outcomes were recorded. Technical success (defined by cessation of flow to the vessel responsible for misperfusion) and clinical success (ie, successful use of the pump) were calculated. RESULTS During the study period, 475 HAIPs were implanted. Of those, 43 (9%) had abnormal nuclear scintigraphic findings of misperfusion, but only 32 (7%) had angiographic abnormalities. In eight of 32 cases, hepatic arterial thrombosis and extravasation at the catheter tip were found, which precluded salvage by embolization. In 24 of 32 cases, a vessel presumed responsible for the misperfusion was identified and targeted for embolization. Technical success and clinical success were achieved in 21 of 24 patients (87.5%) and 19 of 24 patients (79%), respectively, who underwent 27 embolization procedures. The three technical failures (12.5%) were the result of inability to catheterize the identified vessel. CONCLUSIONS Percutaneous arterial embolization of a vessel to correct misperfusion shown by nuclear scintigraphy is safe and effective. This approach can be expected to result in HAIP salvage in the majority of patients.
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Affiliation(s)
- Constantinos T Sofocleous
- Division of Interventional Radiology and Image-Guided Therapies, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
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