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• W3210132094 abstract "Purpose: RAPID is a new surgical technique for unresectable ColoRectal Liver Metastases. It enables little grafts for transplantation, overcoming the small-for size syndrome and expanding the donor pool. The aim of our proof of concept is to show safety and feasibility of this cutting-edge surgery and to approach transplant to a minimally invasive setting. Method: On the basis of our surgical experience, we decided to apply technical refinements to the original technique to overcome some critical issues. 1) Microwave Thermal Ablation along future transection plan to improve oncological radicality and favour a near-bloodless parenchymal resection 2) Autologous saphenous vein ring graft application on the left supra-hepatic vein to optimize graft outflow and avoid kinking 3) Laparoscopic second stage hepatectomy to speed up the post-operative course. We performed two cases in wich we applied our technical refinements. No major complications occurred. Currently, both patients are alive: the first one almost 29 months after transplantation. Result: 1) The use of MWA creates an avascular separation and a necrotic groove between the cancer and the FLR in the future transection plan, allowing an easier left hepatectomy. This considerably limits blood loss. It also improves the oncological radicality on the section shear: negative transection plane was confirmed pathologically. 2) The saphenous ring implanted on the left supra-hepatic vein of the graft avoided the kinking phenomenon ensuring better stability of the anastomosis. The outflow has been greatly improved, as confirmed by doppler-US, with consequent lower probability of complications such as portal thrombosis. It guaranteed optimum portal pressure for the graft, which is the main factor for rapid hypertrophy. 3) In laparoscopic second stage (right hepatectomy) minimal blood losses were recorded. This ensured a lower operative shock for the patients. There was a more rapid postoperative functional recovery. At least in a speculative way, we showed that laparoscopy should be preferred over the open approach. Conclusion: Our experience has underlined the feasibility of this cutting-edge surgery, confirming donor, graft and recipient safety. Our technical refinements might have opened the way to a partial conversion of this aggressive procedure into a minimally invasive setting. In times of organ paucity, LD-RAPID procedure might represent a potential breakthrough in the management of i-CRLM." @default.
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• W3210132094 date "2021-01-01" @default.
• W3210132094 modified "2023-09-27" @default.
• W3210132094 title "Technical Refinements to the RAPID Technique: A Potential Breakthrough in Transplant Oncology" @default.
• W3210132094 doi "https://doi.org/10.1016/j.hpb.2021.08.068" @default.
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