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Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

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Related in: MedlinePlus

A bench resection of segments I, IV to VIII was performed under ex situ conditions. The inferior vena cava and the liver veins were reconstructed using parts of the more distal inferior vena cava which itself was replaced by a Gore-Tex prosthesis.
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Figure 3: A bench resection of segments I, IV to VIII was performed under ex situ conditions. The inferior vena cava and the liver veins were reconstructed using parts of the more distal inferior vena cava which itself was replaced by a Gore-Tex prosthesis.

Mentions: The 72-year-old patient was suffering from a liver metastasis located in segment I. The metastasis had infiltrated the caudal walls of the right, middle, and left hepatic vein (Figure 2). The tumor was only resectable together along with part of the inferior caval vein and parts of the liver veins; therefore an ex situ liver resection was planned. After laparotomy and exclusion of extrahepatic tumor manifestation, the veno-venous bypass was started after integration of two leukocyte adhesion filters in all four patients. During the liver mobilization phase, venous blood was filtrated continuously (in all four patients) after infradiaphragmal inferior vena cava (IVC) clamping. After total hepatectomy, a bench resection of the segments I, IV to VIII, and reconstruction of the middle and left hepatic vein and the IVC was done (Figure 3). During the ex vivo surgical procedure, the liver was perfused in 30 minute intervals through portal vein and hepatic artery using histidine-tryptophan-ketoglutarante solution. The auto-transplantations of the remnant liver followed the techniques applied in cadaver liver grafting.


Extracorporeal tumor cell filtration during extended liver surgery: first clinical use of leukocyte depletion filters--case series.

Oldhafer KJ, Stavrou GA, Donati M, Kaudel P, Frühauf NR - World J Surg Oncol (2013)

A bench resection of segments I, IV to VIII was performed under ex situ conditions. The inferior vena cava and the liver veins were reconstructed using parts of the more distal inferior vena cava which itself was replaced by a Gore-Tex prosthesis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721985&req=5

Figure 3: A bench resection of segments I, IV to VIII was performed under ex situ conditions. The inferior vena cava and the liver veins were reconstructed using parts of the more distal inferior vena cava which itself was replaced by a Gore-Tex prosthesis.
Mentions: The 72-year-old patient was suffering from a liver metastasis located in segment I. The metastasis had infiltrated the caudal walls of the right, middle, and left hepatic vein (Figure 2). The tumor was only resectable together along with part of the inferior caval vein and parts of the liver veins; therefore an ex situ liver resection was planned. After laparotomy and exclusion of extrahepatic tumor manifestation, the veno-venous bypass was started after integration of two leukocyte adhesion filters in all four patients. During the liver mobilization phase, venous blood was filtrated continuously (in all four patients) after infradiaphragmal inferior vena cava (IVC) clamping. After total hepatectomy, a bench resection of the segments I, IV to VIII, and reconstruction of the middle and left hepatic vein and the IVC was done (Figure 3). During the ex vivo surgical procedure, the liver was perfused in 30 minute intervals through portal vein and hepatic artery using histidine-tryptophan-ketoglutarante solution. The auto-transplantations of the remnant liver followed the techniques applied in cadaver liver grafting.

Bottom Line: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.Effectiveness of CK+ cell depletion and safety of the procedure was shown.The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22293 Hamburg, Germany. k.oldhafer@asklepios.com

ABSTRACT

Background: During oncologic surgery, intraoperative manipulation of tumor tissue is almost unpreventable and causes a high risk of tumor cell dissemination into venous blood. A tumor cell-reducing effect of leukocyte adhesion filter systems has been shown under in vitro conditions.

Methods: In a first clinical attempt, leukocyte adhesion filters were integrated into veno-venous bypass systems in four patients undergoing extended liver surgery for secondary hepatic malignancies.Practicability, handling, and safety aspects as well as potency of cell removal and clinical side effects of the filter system were analyzed.

Results: All patients tolerated the application of the system without problems during operative and postoperative follow-up. Immunohistochemical staining of perioperative blood samples detected cytokeratin positive (CK+) cells in three cases during the hepatic mobilization.

Conclusions: Effectiveness of CK+ cell depletion and safety of the procedure was shown. The presented surgical technique represents a safe and innovative tool; however, clinical significance has to be examined in a larger patient cohort.

Show MeSH
Related in: MedlinePlus