By John L. Marshall (Editor)
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Additional resources for Managing Colorectal Cancer: The Resectable and Potentially Resectable Patient, a Multidisciplinary Approach
Sinusoidal Injury Sinusoidal injury has been reported following chemotherapy for advanced CRC, typically characterized by sinusoidal dilation, perisinusoidal fibrosis, centrilobular vein fibrosis, and sinusoidal obstruction (2,18,19). Severe cases of sinusoidal injury, resulting in sinusoidal obstruction syndrome or veno-occlusive disease have also been documented (Figure 3). Clinically, patients with significant sinusoidal obstruction syndrome can present with markedly elevated bilirubin, hepatosplenomegaly, right upper quadrant pain, and fluid retention (18).
In type IV, the surgical technique must be modified whether 34 Role of Imaging in the Management of Patients the lesion affects the right or left lobe. In type V, if the lesion affects the left lobe, the accessory LHA must be ligated from the LGA to avoid excessive hemorrhage. In type VI, if the lesion affects the right lobe, ligation of the accessory right hepatic artery must be considered. In type VII, additional surgical steps must be taken regardless of lesion location. In type VIII, modification of technique is required depending on which replaced artery is present, and additional ligating procedures are required depending on which accessory artery is present.
Confluence of the right and left hepatic ducts usually occurs in up to 75% of patients. A triple confluence of the right and left hepatic ducts, with the division of the right anterior and posterior sectoral ducts with a left hepatic duct, occurs in up to 15% of patients. In 6%–8%, a right sectoral duct may join the left hepatic duct. In 3%, there may be absence of the hepatic duct confluence, and in 2%, a right posterior sectoral duct may join the neck of gallbladder. 36 Role of Imaging in the Management of Patients Evaluation of Treatments That Allow Curative Hepatic Resection As mentioned earlier, current surgical trends have expanded the indications for surgical resection, and the development of new strategies, such as neo-adjuvant chemotherapy, PVE, or two-stage resection, have allowed a larger number of patients to enjoy longer survival.