Innovative approaches for non-resectable liver tumors

Aims

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1. Clinical trial on a highly novel surgical approach to overcome ‘non-resectable’ liver tumors using ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy), a two-step procedure with an as yet unprecedented liver regeneration. Many patients with a variety of tumor, previously felt to be inoperable, can now be cured with this novel approach.
2. Translational study in the laboratory to dissect the mechanism of liver regeneration and impact on tumor growth in a newly established mouse model of ALPPS.
3. Clinical trials and outcome studies to compare ALPPS with living related liver transplantation in selected groups of patients presenting with non-resectable liver tumors. We will mostly focus on cholangiocarcinoma, for which we have an IRB approved protocol for liver transplantation. We will include in such study diagnostic monitoring of tumor cell seeding and correlate them with outcome (tumor recurrence).



Figure: Strategies for safer removal of large or multiple liver tumors.
A Portal vein embolization to increase the future remnat liver
B Two-staged hepatectomy (Adam 2000)
C Portal vein embolization (Jaeck 2003) followed by two-staged hepatectomy
D Portal vein ligation and two-staged hepatectomy (Clavien 2007)

E ALPPS (Schlitt 2012). Tumors are highlighted in yellow. The shaded areas indicate the removed part of the liver.