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Li P, Wang M, Yang Y, Liu H, Pan Z, Jiang B, Lau WY, Huang G, Zhou W. Preoperative three-dimensional versus two-dimensional evaluation in assessment of patients undergoing major liver resection for hepatocellular carcinoma: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:182. [PMID: 32309329 PMCID: PMC7154448 DOI: 10.21037/atm.2020.01.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Compared with 2D evaluation, 3D evaluation possesses the virtues of displaying spatial anatomy of intrahepatic blood vessels and its relations to tumors, and enabling calculation of liver volumes, thus facilitating preoperative surgery planning. Methods The objective of this study is to study whether preoperative 3D (three-dimensional) evaluation produced better long-term overall survival (OS) outcomes compared to the traditional 2D (two-dimensional) evaluation in patients who underwent major hepatectomy for hepatocellular carcinoma (HCC). This retrospective study matched patients who underwent preoperative 2D evaluation with those who underwent preoperative 3D evaluation in a 1:1 ratio using propensity score matching. The primary endpoints were long-term survival outcomes in the two groups after major hepatectomy for HCC. Results Of the 248 patients in each of the 2 matched groups, the baseline characteristics were comparable. The median follow-up for all patients was 36 months (range, 0-40 months). The 3-year OS of patients in the PSM cohort was 38.5%. Compared with the 2D Group, patients in the 3D Group had a better OS rate (HR 0.722, 95% CI: 0.556-0.938, P=0.015) and disease-free survival (DFS) rate (HR 0.741, 95% CI: 0.590-0.929, P=0.009). The 3-year OS and DFS rate for the 3D Group versus the 2D group were 58.9% and 44.0% versus 47.4% and 33.1%, respectively. Conclusions 3D preoperative evaluation resulted in significantly better intermediate-term (3-year) overall survival rate than the traditional 2D evaluation.
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Affiliation(s)
- Pengpeng Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Mengchao Wang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Yuan Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Hui Liu
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Zeya Pan
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Beige Jiang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Gang Huang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
| | - Weiping Zhou
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
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López-Guerra D, Santos-Naharro J, Rojas-Holguín A, Jaen-Torrejimeno I, Prada-Villaverde A, Blanco-Fernández G. Postoperative bleeding and biliary leak after liver resection: A cohort study between two different fibrin sealant patches. Sci Rep 2019; 9:12001. [PMID: 31427638 PMCID: PMC6700165 DOI: 10.1038/s41598-019-48529-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
Different topical products have been tested in liver resection to get a control of bleeding. This study compares the effectiveness and complications between two haemostatic agents Tachosil versus Hemopatch. A cohort study including patients who underwent liver resection since November 2014 to April 2016 was conducted. The study was performed in a single institution. Demographic variables, intraoperative characteristics and postoperative complications were analysed. A total of 92 patients (50 in Tachosil group and 42 in Hemopatch group) were included. No differences were found in patients who required intraoperative (Tachosil 6 (12%) vs Hemopatch 2 (4.8%); p = 0.28) and postoperative (Tachosil 4 (8%) vs Hemopatch 3 (7.1%); p = 0.87) blood transfusion. There were no differences in length of hospital stay (Tachosil 7.02 ± 4.1 days vs Hemopatch 7.63 ± 9.1; p = 0.67). Overall postoperative complications were similar between both patches (Tachosil 21 (42%) vs Hemopatch 14 (33%); p = 0.48). No differences were found in specific complications, however Hemopatch showed a higher incidence of intraabdominal abscess 5 (11.9%) and vs 0 (0%) p = 0.01.In this study no differences have been found between Hemopatch and Tachosil in the effectiveness and overall postoperative complication after liver resection, although Hemopatch shows a higher incidence of intraabdominal abscess. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Diego López-Guerra
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain.
| | - Jesús Santos-Naharro
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Isabel Jaen-Torrejimeno
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Aranzazu Prada-Villaverde
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and liver transplant surgery, Hospital Universitario Infanta Cristina, University of Extremadura, Badajoz, Spain
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Karadeniz E, Ozbilgin M, Egeli T, Agalar C, Cevlik AD, Aysal A, Ellidokuz H, Unek T, Astarcioglu I. Assessment of Effect of Intraperitoneal Tacrolimus on Liver Regeneration in Major (70%) Hepatectomy Model After Experimental Pringle Maneuver in Rats. Transplant Proc 2019; 51:1172-1179. [PMID: 31101194 DOI: 10.1016/j.transproceed.2019.01.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
AIM Small-for-size grafts have become more important, especially in living donor liver transplants. The Pringle maneuver, used to reduce blood loss, and the immunosuppressive medications used to prevent graft rejection in liver transplants have different side effects on liver regeneration. We researched the effect of situations where tacrolimus and the Pringle maneuver were applied or not on liver regeneration in rats with partial hepatectomy. MATERIAL AND METHODS This study was completed with 35 Wistar Albino rats. The subjects were randomly divided into 5 groups: Group 1 had the abdomen opened and no other procedure was performed; Group 2 underwent a 70% hepatectomy; Group 3 underwent a 15-minute Pringle maneuver + 70% hepatectomy; Group 4 underwent a 70% hepatectomy + 5 days of 1 mg/kg/day intraperitoneal tacrolimus; and Group 5 underwent a 150 minute Pringle maneuver + 0% hepatectomy + 5 days of 1 mg/kg/day intraperitoneal tacrolimus. All rats were sacrificed on the seventh postoperative day, remaining liver tissue was weighed, and weight indices created. The remaining liver tissue was stained with phosphohistone H3 and the mitotic index calculated. RESULTS The groups that underwent the Pringle maneuver, 70% hepatectomy, and tacrolimus administration were compared with the control group in terms of mitotic index and weight index, but no statistically significant differences were identified. CONCLUSION Suppression of regeneration forms a risk after liver transplantation with small-volume grafts. As a result, research on the effect of tacrolimus combined with the Pringle maneuver is important, especially for transplantations using segmented liver grafts. In our study, we showed that the use of tacrolimus had no negative effect on liver regeneration.
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Affiliation(s)
- E Karadeniz
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - M Ozbilgin
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - T Egeli
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - C Agalar
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - A D Cevlik
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - A Aysal
- Department of Pathology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - H Ellidokuz
- Department of Preventive Oncology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - T Unek
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - I Astarcioglu
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Nouri S, Sharif MR. Use of ferric sulfate to control hepatic bleeding. Trauma Mon 2015; 20:e25257. [PMID: 25825702 PMCID: PMC4362037 DOI: 10.5812/traumamon.25257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Controlling parenchymal hemorrhage, especially in liver parenchyma, despite all the progress in surgical science, is still one of the challenges surgeons face. Therefore, search for an effective method to control hepatic bleeding is an important research priority. Objectives: This study attempted to determine the haemostatic effect of ferric sulfate and compare it with the standard method (suturing technique). Materials and Methods: In this animal model study, 60 male Wistar rats were used. An incision (2 cm in length and 1/2 cm in depth) was made on each rat’s liver and the hemostasis time was measured using ferric sulfate with different concentrations (5%, 10%, 15%, 25%, and 50%) and then using simple suturing. The liver tissue was assessed for pathological changes. Results: In all the groups, complete hemostasis occurred. Hemostasis times of different concentrations of ferric sulfate were significantly less than those of the control group (P < 0.001). Conclusions: Ferric sulfate was effective in controlling hepatic bleeding in rats.
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Affiliation(s)
- Saeed Nouri
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Sharif, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9123788713, Fax: +98-3615558900, E-mail:
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A randomized clinical trial comparing the effect of different haemostatic agents for haemostasis of the liver after hepatic resection. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2013; 2013:587608. [PMID: 24159254 PMCID: PMC3789495 DOI: 10.1155/2013/587608] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/10/2013] [Accepted: 08/10/2013] [Indexed: 11/22/2022]
Abstract
Introduction. Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it. The aim of the current study is to evaluate effects of 3 different types of these agents. Methods. In this randomized clinical trial, 45 patients undergoing liver resection were assigned to receive TachoSil, Surgicel, and Glubran 2 for controlling bleeding. Intraoperative and postoperative findings were compared between groups. Results. Postoperative bleeding (0 versus 33.3%, P = 0.04) and drainage volume first day after surgery (281.33 ± 103.98 versus 150.00 ± 60.82 mL, P = 0.02) were significantly higher in Surgicel than in TachoSil group. Postoperative complications included bile leak (3 cases in Surgicel, 1 case in TachoSil and Glubran 2), noninfectious collection (2 cases in TachoSil and Surgicel and 1 case in Glubran 2), perihepatic abscess, and massive hematoma around hepatectomy site both in Surgicel group. There was no death during the study period. Conclusion. Due to higher complications in Surgicel group, its application as hemostatic agent after liver resection is not recommended. Better results in TachoSil in comparison to the other two are indicative of its better efficacy and superiority in controlling hemostasis.
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Duan CH, Tai S. Progress in treatment of hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis. Shijie Huaren Xiaohua Zazhi 2013; 21:2294-2299. [DOI: 10.11569/wcjd.v21.i23.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) with compressed inferior vena cava (IVC) or IVC tumor thrombosis (IVCTT) is an advanced-stage disease that has traditionally been considered a relative contraindication for surgical management and therefore has an extremely poor prognosis. Non-surgical treatment for these patients can lead to tumor invasion to the right atrium, which can cause heart failure and sudden death. In recent years, the development of innovative surgical techniques has made a curative surgical approach to tumors involving both the liver and IVC possible. The purpose of this article is to review the progress in treatment of HCC with IVC invasion and/or thrombosis.
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Ding H, Yuan JQ, Zhou JH, Zheng XY, Ye P, Mao C, Chen Q. Systematic review and meta-analysis of application of fibrin sealant after liver resection. Curr Med Res Opin 2013; 29:387-94. [PMID: 23339601 DOI: 10.1185/03007995.2013.768216] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fibrin sealant (FS) has been increasingly used on the raw surface after liver resection but its clinical value has not been established to date. The aim of this study was to evaluate the efficacy and safety of the employment of FS after liver resection. METHODS PubMed, Cochrane Library, Embase, CNKI, CBM and VIP were searched for randomized trials comparing the effect of FS with no FS or any other intervention for patients undergoing liver resection. Primary outcomes included time to hemostasis, hemostatic success, amount of drainage and drainage duration. RESULTS Eleven randomized controlled trials were included. Meta-analysis suggested that the amount of drainage (standard mean difference -0.30; 95% confidence interval [CI] -0.82 to 0.23) and drainage duration (mean difference [MD] -0.46, 95% CI -0.61 to -1.53) were similar between FS group and no FS group. Compared with topical hemostatic agents, FS could significantly reduce time to hemostasis (MD -208.46, 95% CI -228.22 to -188.70) and increase hemostasis success rate (relative risk 1.35, 95% CI 1.17 to 1.57). Two trials compared FS with argon beam coagulation (ABC), which both suggested that FS could significantly decrease the time to hemostasis. CONCLUSIONS This study demonstrated a modest benefit of FS over no FS, topical hemostatic agents and ABC in controlling intraoperative bleeding from the raw liver surface after liver resection. But there is no evidence that FS is beneficial to patients in reducing amount of drainage and drainage duration.
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Affiliation(s)
- Hong Ding
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
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Metrakos P, Kakiashvili E, Aljiffry M, Hassanain M, Chaudhury P. Role of Surgery in the Diagnosis and Management of Metastatic Cancer. EXPERIMENTAL AND CLINICAL METASTASIS 2013:381-399. [DOI: 10.1007/978-1-4614-3685-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Abstract
The incidence of complications after hepatectomy has been considerably reduced over the last 20 years. Better knowledge of liver anatomy and liver regeneration, and methods preventing bleeding during surgery have resulted in morbidity rates below 20% and mortality rates less than 5%. The treatment of the liver cross section remains controversial. Experimental studies have reported convincing biological effects of fibrin sealants or compresses when applied on the liver to decrease hemorrhagic or biliary complications. However, clinical studies are very heterogeneous, providing conflicting results compromising recommendations for routine use.
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10
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Takács I, Wegmann J, Horváth S, Ferencz A, Ferencz S, Jávor S, Odermatt E, Rõth E, Weber G. Efficacy of different hemostatic devices for severe liver bleeding: a randomized controlled animal study. Surg Innov 2010; 17:346-52. [PMID: 20870671 DOI: 10.1177/1553350610384405] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Correct hemostasis in liver surgery is hard to achieve because of the oozing bleeding. The aim of this study was to compare the potential benefits of a new compress to the 2 commercial hemostatic compresses. METHODS Collagen- and cellulose-based hemostatics were investigated. A standardized resection was treated by applying different hemostatics in a randomized order, and bleeding times were measured. Macroscopic evaluation of the liver and tissue sampling for histological investigations were carried out after 21 days. RESULTS The bleeding times of bovine collagen (BoCo), protein-coated equine collagen (PECo), and oxidized cellulose (OxCe) were 140 ± 88, 243 ± 140 (P = .005 vs BoCo), and 352 ± 70 s (P < .001 vs BoCo), respectively. Microscopic evaluation of the PECo presented fibrosis and significant inflammation in the implantation zone, whereas BoCo and OxCe caused only fibrosis in the wound area. CONCLUSION BoCo showed significantly better hemostatic effect than PECo and OxCe.
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Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery 2010; 149:48-55. [PMID: 20385397 DOI: 10.1016/j.surg.2010.02.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 02/12/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this trial was to confirm previous results demonstrating the efficacy and safety of a fixed combination tissue sealant versus argon beam coagulation (ABC) treatment in liver resection. METHODS This trial was designed as an international, multicenter, randomized, controlled surgical trial with 2 parallel groups. Patients were eligible for intra-operative randomization after elective resection of ≥ 1 liver segment and primary hemostasis. The primary end point was the time to hemostasis after starting the randomized intervention to obtain secondary hemostasis. Secondary end points were drainage duration, volume, and content. Adverse events were collected to evaluate the safety of treatments. The trial was registered internationally (Eudract number 2008-006407-23). RESULTS Among 119 patients (60 TachoSil and 59 ABC) randomized in 10 tertiary care centers in Europe, the mean time to hemostasis was less when TachoSil was used (3.6 minutes) compared with ABC (5.0 minutes; P = .0018). The estimated ratio of mean time to hemostasis for TachoSil/ABC was 0.61 (95% confidence interval, 0.47-0.80; P = .0003). Postoperative drainage volume, drainage fluid, and drainage duration did not differ between the 2 groups. Mortality (2 vs 4 patients) and adverse reactions (24 vs 28 patients) for TachoSil versus ABC did not differ. CONCLUSION This trial confirmed that TachoSil achieved significantly faster hemostasis after liver resection compared with ABC. Postoperative morbidity and mortality remained unchanged between both groups.
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Affiliation(s)
- Lars Fischer
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
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12
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Sun HC, Zhuang PY, Qin LX, Ye QH, Wang L, Ren N, Zhang JB, Qian YB, Lu L, Fan J, Tang ZY. Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol 2007; 96:37-45. [PMID: 17345597 DOI: 10.1002/jso.20772] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To study lymph node metastasis (LNM) and prognosis in patients with operable hepatocellular carcinoma (HCC) as well as the value of routine complete lymphadenectomy. Few studies have been reported on LNM in patients with operable HCC. METHODS Lymph node enlargement of 968 patients with operable HCC was carefully explored and LNM was diagnosed by typical intraoperative findings or pathology. RESULTS Forty-nine (5.1%) patients had LNM, which was associated with advanced tumor properties. The 1-, 3-, and 5-year overall survival in patients with LNM was poorer than those without LNM (62.0%, 31.0%, and 26.0% vs. 81.0%, 62.0%, and 47.0%, P = 0.000). The 1-, 3-, and 5-year overall survival in patients who received complete lymphadenectomy (n = 26) was poorer than those without LNM (68.0%, 31.0%, and 31.0% vs. 81.0%, 62.0%, and 47.0%, P = 0.017), and was not better than patients who received chemotherapy or radiotherapy (P = 0.944). CONCLUSION The incidence of LNM in operable HCC patients was low, and patients with LNM had a poorer prognosis. LNM status determined the disease-free survival but not the overall survival of HCC. The complete lymphadenectomy did not improve overall survival, as compared with chemotherapy or radiotherapy.
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Affiliation(s)
- Hui-Chuan Sun
- Live Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
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Chen XP, Qiu FZ, Wu ZD, Zhang ZW, Huang ZY, Chen YF. Long-term outcome of resection of large hepatocellular carcinoma. Br J Surg 2006; 93:600-6. [PMID: 16607679 DOI: 10.1002/bjs.5335] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The role of hepatectomy in the treatment of large hepatocellular carcinoma (HCC) is still controversial. This retrospective study evaluated whether the long-term outcome of hepatectomy for large HCC improved over 14 years in one centre. METHODS Data from 2102 patients who underwent hepatectomy for large HCC were collected prospectively and divided into two time intervals for analysis: before end of December 1996 (group 1) and after December 1996 (group 2). Clinicopathological data for the two groups were compared, and factors associated with long-term prognosis were further analysed. RESULTS Cumulative 1-, 3- and 5-year overall survival rates were 71.2, 58.8 and 38.7 per cent respectively in group 2, and were significantly better than respective rates of 67.8, 50.7 and 27.9 per cent in group 1. Cumulative 1-, 3- and 5-year disease-free survival rates were 61.5, 38.6 and 23.8 per cent respectively in group 2, and 56.5, 34.7 and 18.9 per cent in group 1. There was a significant difference in median survival time after recurrence between groups 2 and 1 (17 and 10 months respectively; P = 0.043). CONCLUSION Hepatic resection in patients with large HCC has improved overall and disease-free survival during the past decade at this institute. Long-term survival can be improved significantly by aggressive treatment of recurrent tumours.
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Affiliation(s)
- X-P Chen
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Sun HC, Qin LX, Lu L, Wang L, Ye QH, Ren N, Fan J, Tang ZY. Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg 2006; 93:422-6. [PMID: 16491462 DOI: 10.1002/bjs.5260] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Abdominal drainage is a standard procedure after hepatectomy, but this practice has been challenged recently. METHODS Between September 2004 and March 2005, 120 consecutive patients who had undergone hepatic resection by the same surgical team were randomly allocated into drainage and no drainage groups (60 in each group). Patient characteristics, preoperative liver function, presence of cirrhosis, resection-related factors and postoperative complications were compared between the two groups. RESULTS The groups were comparable in terms of demographics, indications for surgery, preoperative liver function test results, presence of cirrhosis, extent of hepatectomy, intraoperative blood loss and requirement for blood transfusion. Symptomatic subphrenic collection and pleural effusion occurred in four patients (7 per cent) who had abdominal drainage and three (5 per cent) who did not. Local wound complications occurred in 17 (28 per cent) and two (3 per cent) patients respectively (P < 0.001). The postoperative hospital stay was similar in the two groups. Multivariate analysis indicated that the presence of cirrhosis and abdominal drainage were independently related to the development of postoperative wound complications. CONCLUSION Routine abdominal drainage is unnecessary after elective hepatectomy using the crushing clamp method.
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Affiliation(s)
- H-C Sun
- Liver Cancer Institute and Zhong Shan Hospital, Fudan University, Shanghai 200032, China.
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Hsieh CB, Chang HM, Chen TW, Chen CJ, Chan DC, Yu JC, Liu YC, Chang TM, Shen KL. Comparison of transcatheter arterial chemoembolization, laparoscopic radiofrequency ablation, and conservative treatment for decompensated cirrhotic patients with hepatocellular carcinoma. World J Gastroenterol 2004; 10:505-8. [PMID: 14966906 PMCID: PMC4716969 DOI: 10.3748/wjg.v10.i4.505] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To compare the therapeutic effect of transcatheter arterial chemoembolization (TACE), laparoscopic radiofrequency ablation (LRFA), and conservative treatment for the therapy of decompensated liver cirrhosis patients with hepatocellular carcinomas (HCC).
METHODS: Between October 2000 and July 2003, one hundred patients with histologically proven primary HCC and clinical decompensated liver cirrhosis (Child classification B or C) were included in this study. Forty patients received LRFA (LRFA group), twenty received TACE (TACE group), and forty received conservative treatment (control group). We compared the survival, recurrence, and complication rates in these three groups, making adjustment using the tumor metastastic node staging system.
RESULTS: The major complication rate in the TACE group (9/20) was significantly higher than that in the LRFA group (7/40). For patients with TMN stage II HCC, the survival rate of the LRFA group was better than that of the TACE and control groups (P = 0.003) but the recurrence rates befween the LRFA and TACE groups did not differ.
CONCLUSION: The LRFA group of patients had better clinical outcomes in terms of survival and complication rates in comparison with the TACE group or conservative treatment in patients with decompensated liver cirrhosis, especially in TMN patients with stage II HCC. LRFA is thus an appropriate alternative treatment for poor liver function among patients with HCC.
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Affiliation(s)
- Chung-Bao Hsieh
- Division of General Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, 325 Sec 2 Cheng-Kung Road, Taipei, Taiwan, China.
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Affiliation(s)
- Leonidas G Koniaris
- Department of Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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Abstract
Hepatic metastases occur in 60% of patients following resection for colorectal cancer. Liver resection is the only curative option, with one third of resected patients alive at five years. In those developing recurrence in the liver following resection, further liver surgery may be curative, with similar 5 years survival rates of about 30%. Until recently surgery was feasible in only 15-25% of patients with colorectal liver metastases. New strategies, such as downstaging chemotherapy, portal vein embolization and two-stage hepatectomy, may increase the resectability rate by 15%. Earlier detection of liver metastases would increase resectability, although good follow-up trials are lacking. Once suspected, colorectal liver metastases are staged by spiral CT, CT portography and MRI, which have similar overall accuracies. Mortality following liver resection is less than 5% in major centres, with a morbidity rate of 20% to 50%. Prognostic scoring systems can be used to predict the likely cure rate with resection. Pulmonary metastases occur in 10-25% of patients with resected colorectal cancer, but are limited to the lung in only 2% of cases. In these selected cases surgery provides long-term survival in 20-40%, and repeat lung resection has shown similar rates. For patients with unresectable disease, chemotherapy and ablation techniques have been demonstrated to prolong survival, although chemotherapy alone has been shown to improve quality of life.
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Affiliation(s)
- G Fusai
- University Department of Surgery and Liver Transplant Unit, Royal Free Hospital, Royal Free and University College Medical School, Pond Street, London NW3 1QG, UK
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Schindl M, Gruenberger T, Langle F. Current Strategies in the Treatment of Colorectal Cancer Liver Metastases: Aspects of Surgical Treatment. Eur Surg 2002. [DOI: 10.1046/j.1563-2563.2002.02078.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Yanaga K, Kamohara Y, Takatsuki M, Furui J, Kanematsu T. Vertical portal vein clamping in right hepatic lobectomy for live donation or neoplasm. Liver Transpl 2002; 8:565-7. [PMID: 12037790 DOI: 10.1053/jlts.2002.33453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A modified technique is described in clamping the right branch of the portal vein in right hepatic lobectomy for live donation or neoplasm that allows flush division of the origin of the right branch without causing portal vein stenosis.
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Affiliation(s)
- Katsuhiko Yanaga
- Department of Surgery II, Nagasaki University School of Medicine, Nagasaki, Japan.
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