K. Imai

Outcome after associating liver partition and portal vein ligation for staged hepatectomy and conventional two-stage hepatectomy for colorectal liver metastases.

Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two‐stage hepatectomy is still unknown.

Long‐term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases

Combining radiofrequency ablation (RFA) with hepatectomy may enable treatment with curative intent for patients with colorectal liver metastasis (CRLM). However, the oncological outcomes in comparison with resection alone remain to be clarified.

Nomogram for prediction of prognosis in patients with initially unresectable colorectal liver metastases.

Although recent advances in surgery and chemotherapy have increasingly enabled hepatectomy in patients with initially unresectable colorectal liver metastases (CRLM), not all such patients benefit from surgery. The aim of this study was to develop a nomogram to predict survival after hepatectomy for initially unresectable CRLM.

Potential of a cure in patients with colorectal liver metastases and concomitant extrahepatic disease

We aimed to define the cure rate in patients with colorectal liver metastases (CRLM) and concomitant extrahepatic disease (EHD) on the 5‐year disease‐free survival (DFS) after surgery, and identify the factors for predicting a cure.

Two-Stage Liver Surgery

Although surgical resection is still the only treatment that can provide prolonged survival and a hope of cure for patients with colorectal liver metastases (CLM), many patients are thought to be unresectable at the time of diagnosis. During the last two decades, the advent of more effective chemotherapy and developments of surgical procedure have expanded the pool of resectable patients with CLM, and a certain number of patients with initially unresectable CLM can be converted to resectable. However, even with effective chemotherapy with or without targeted therapy, conversion rate is reported to be only 20%. For patients with extensive bilateral multinodular CLM, a single hepatectomy, even with specific procedures such as portal vein embolization (PVE) and local ablation therapy is sometimes not sufficient to treat all the tumors. The concept of two-stage hepatectomy (TSH) to treat patients with multiple bilateral unresectable CLM was first introduced by our team in 1992 and published in 2000. This strategy aims to remove all the tumors in two sequential procedures, removing tumors from the less-invaded lobe during first-stage in most cases, and inducing hypertrophy of the future liver remnant before second-stage in order to avoid the risk of postoperative liver failure. Since then, many specialized centers have adopted, developed, and modified this strategy. This procedure has evolved greatly in the last decade in combination with PVE and effective chemotherapy, resulting in promising short- and long-term outcomes. Herein, we describe the history, surgical technique, indication, drawbacks and outcomes of TSH for CLM.

Idiosyncratic drug‐induced liver injury: A short review

Idiosyncratic drug‐induced liver injury (iDILI) is a rare adverse drug reaction that occasionally leads to acute liver failure or even death. An aging population that uses more drugs, a constant influx of newly developed drugs, and a growing risk from herbal and dietary supplements of uncertain quality can lead to an increase in iDILI. Antimicrobials, central nervous system agents, and herbal and dietary supplements are the most common causes of iDILI in developed countries. iDILI is still a diagnosis of exclusion, and thus careful history taking and thorough work‐ups for competing etiologies, such as acute viral hepatitis, autoimmune hepatitis, and others, are essential. The pathogenesis of iDILI is not clear and includes a mix of host reactions, drug metabolites, and environmental factors. Immediate cessation of the suspected offending drug is key to preventing or minimizing progressive damage. No definitive therapies for iDILI are available, and the treatments remain largely supportive. (Hepatology Communications 2017;1:494–500)