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Huang K, Chen Z, Xiao H, Hu HY, Chen XY, Du CY, Lan X. Laparoscopic liver resection utilizing the ventral avascular area of the inferior vena cava: A retrospective cohort study. World J Gastroenterol 2025; 31:100750. [PMID: 39777238 PMCID: PMC11684186 DOI: 10.3748/wjg.v31.i1.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/28/2024] [Accepted: 11/18/2024] [Indexed: 12/09/2024] Open
Abstract
BACKGROUND Laparoscopic liver resection (LLR) can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy. Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization, tumor compression, and bleeding from the short hepatic veins (SHVs). This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava (IVC), allowing SHVs to be addressed after parenchymal transection, thereby reducing surgical complexity and improving outcomes in in situ LLR. AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods. METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. In novel LLR, we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC. Then, we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker. Subsequently, we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein. The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared. RESULTS A total of 256 patients were included, with 150 (58.59%) undergoing conventional LLR and 106 (41.41%) undergoing novel LLR. The novel technique resulted in significantly larger tumor resections (6.47 ± 2.96 cm vs 4.01 ± 2.33 cm, P < 0.001), shorter operative times (199.57 ± 60.37 minutes vs 262.33 ± 83.90 minutes, P < 0.001), less intraoperative blood loss (206.92 ± 37.09 mL vs 363.34 ± 131.27 mL, P < 0.001), and greater resection volume (345.11 ± 31.40 mL vs 264.38 ± 31.98 mL, P < 0.001) compared to conventional LLR. CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression. It facilitates a safer, in situ removal of complex liver tumors, even in challenging anatomical locations. Compared to conventional methods, this technique offers significant advantages, including reduced operative time, blood loss, and improved overall surgical efficiency.
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Affiliation(s)
- Kun Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
- Department of General Surgery, Mianyang Hospital of Traditional Chinese Medicine, Mianyang 621000, Sichuan Province, China
| | - Zhu Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Heng Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Hai-Yang Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Xing-Yu Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Cheng-You Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Xiang Lan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
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Ishii T, Iwaki K, Nakakura A, Uchida Y, Ito T, Hatano E. Is the anterior approach recommended for liver resection of hepatocellular carcinoma? A systematic review and meta-analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:133-142. [PMID: 37984829 DOI: 10.1002/jhbp.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/24/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND/PURPOSE The anterior approach (AA) in liver resection has proven more effective with regard to short-term outcomes than the conventional approach (CA). However, its superiority over the CA concerning long-term outcomes remains unclear. This meta-analysis compared the short- and long-term outcomes of the AA and CA. METHODS Databases, including MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials, were searched to identify studies comparing the AA and CA for hepatocellular carcinoma (HCC) liver resection. The primary outcomes were the in-hospital mortality, in-hospital morbidity, disease-free survival (DFS), and overall survival (OS). Secondary outcomes were operative time, blood loss, blood transfusion, R0 rate, and length of hospital stay. RESULTS Ten studies involving 1369 patients were included (AA, n = 595; CA, n = 774). Despite no significant differences in the in-hospital mortality or morbidity, the AA demonstrated a superior DFS (hazard ratio [HR], 0.63; 95% confidence interval [CI]: 0.51-0.77) and OS (HR, 0.56; 95% CI: 0.48-0.65) and was associated with a longer operative time, less blood loss, and less transfusion than the CA. No marked differences in other outcomes were noted. CONCLUSIONS The AA for HCC liver resection helped reduce blood loss and need for transfusion, improving the DFS and OS.
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Affiliation(s)
- Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Iwaki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoichiro Uchida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Honda M, Isono K, Hirukawa K, Tomita M, Hirao H, Hirohara K, Sakurai Y, Irie T, Mori T, Shimata K, Shimojima N, Sugawara Y, Hibi T. Reappraisal of anatomical liver resection for hepatoblastoma in children. Surg Open Sci 2023; 16:215-220. [PMID: 38035224 PMCID: PMC10687054 DOI: 10.1016/j.sopen.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Background The principle of hepatoblastoma (HB) treatment is complete resection. The removal of tumor-bearing section(s) or hemiliver is widely accepted. However, neither the standardized anterior approach for right hepatectomy nor parenchymal sparing anatomical liver resection has been described for HB. Methods We retrospectively reviewed the clinical course of two pediatric HB patients who underwent extended right hepatectomy using the anterior approach with the liver hanging maneuver and one who underwent parenchymal sparing anatomical liver resection of S4 apical+S8 ventral/dorsal+S7. The critical aspects of surgical techniques are described in detail. Results In all three patients, R0 resection was achieved without complications and are currently alive without recurrence after an average follow-up of 23 months. Intraoperative cardiac hemodynamics were stable, even in a trisomy 18 patient with cardiac disease. Conclusions Our findings suggest that these innovative techniques established in adults are safe and feasible for HB in children. These techniques also allow optimal anatomical liver resection to accomplish curative surgery while maintaining the functional reserve of the remnant liver.
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Affiliation(s)
- Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kazuya Hirukawa
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masahiro Tomita
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Hiroki Hirao
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kazuki Hirohara
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuto Sakurai
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Tomoaki Irie
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Teizaburo Mori
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Rhaiem R, Sommacale D, Zimmermann P, Amroun K, Tashkandi A, Laurent A, Amaddeo G, Calderaro J, Luciani A, Heurgue A, Thiefin G, Piardi T, Kianmanesh R, Brustia R. Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis. J Gastrointest Surg 2023; 27:2092-2102. [PMID: 37407897 DOI: 10.1007/s11605-023-05741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce. In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared. METHODS A retrospective inverse propensity score-weighted fashion (IPTW) case-control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed. RESULTS Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62-1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54-2.6, p = 0.66). After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence. CONCLUSION AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.
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Affiliation(s)
- Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France.
- Reims Champagne-Ardenne University, Reims, France.
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Daniele Sommacale
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Perrine Zimmermann
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Koceila Amroun
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Ahmad Tashkandi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Alexis Laurent
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Giuliana Amaddeo
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Julien Calderaro
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Pathology Department, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Alain Luciani
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Diagnostic Radiology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Alexandra Heurgue
- Reims Champagne-Ardenne University, Reims, France
- Department of Hepatology, Robert Debré University Hospital, Reims, France
| | - Gérard Thiefin
- Reims Champagne-Ardenne University, Reims, France
- Department of Hepatology, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
- Hepatobiliary, Pancreatic and Endocrine Surgery Department, Simon Veil Hospital, Troyes, France
| | - Reza Kianmanesh
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Raffaele Brustia
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
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Tendean M, Lampus HF, Rendy L, Wijaya C, Panelewen J. Technique for liver separation using the modified liver hanging maneuver (LHM) in a case of thoraco-omphalopagus conjoined twins. Int J Surg Case Rep 2023; 110:108613. [PMID: 37643564 PMCID: PMC10509815 DOI: 10.1016/j.ijscr.2023.108613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Conjoined twins are rare, high-stakes cases requiring complex management. This report presents thoraco-omphalopagus conjoined twins who shared parts of liver and abdominal wall. The main obstacle in separating these patients was liver fusion. PRESENTATION OF CASE Two-year-old female conjoined twins presented with liver fusion between segments 2 and 3 in twin A and segments 2 and 4A in twin B. Liver separation was performed using the modified liver hanging maneuver. After separating the triangular ligaments and surrounding adhesions, a 12-Fr Foley catheter was inserted under the fused liver, suspending it upward and producing a clear separation plane. Liver separation required only 32 min. No notable bleeding or bile leakage was observed. DISCUSSION The liver hanging maneuver was originally used as an adjunct technique for liver tumor hepatectomy. We used this technique to separate the fused livers in conjoined twins. The advantages of LHM include potentially reducing excess manipulation, which may result in parenchyma and vascular pedicle injury, and facilitating bleeding control, thereby reducing the operation time. CONCLUSION The liver hanging maneuver using a conventional Foley catheter is a simple and useful method for separating fused livers in conjoined twins.
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Affiliation(s)
- Michael Tendean
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia
| | - Harsali Fransiscus Lampus
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia
| | - Leo Rendy
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia.
| | - Candy Wijaya
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia
| | - Jimmy Panelewen
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi Kandou General Hospital, Manado, Indonesia
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Nevarez NM, Chang GY, Yopp AC. An Overview of Clinical Trials in the Treatment of Resectable Hepatocellular Carcinoma. Surg Oncol Clin N Am 2023; 32:101-117. [PMID: 36410911 DOI: 10.1016/j.soc.2022.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death worldwide. Partial hepatectomy, one of a few curative therapeutic modalities, is plagued by high recurrence rate of up to 70% at 5 years. Throughout the past 3 decades, many clinical trials have attempted to improve HCC recurrence rate following partial hepatectomy using adjuvant and neoadjuvant treatment modalities such as antiviral therapy, brachytherapy, systemic chemotherapy, immunotherapy, transarterial chemoembolization and radioembolization, and radiotherapy. The goal of this review is to discuss the clinical trials pertaining to resectable HCC including surgical technique considerations, adjuvant, and neoadjuvant treatment modalities.
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Affiliation(s)
- Nicole M Nevarez
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Gloria Y Chang
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Adam C Yopp
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Is the anterior approach suitable for laparoscopic right hemihepatectomy in patients with large HCC (5-10 cm)? A propensity score analysis. Surg Endosc 2022; 36:6024-6034. [PMID: 35182216 DOI: 10.1007/s00464-022-09119-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Right hemihepatectomy via the anterior approach was initially employed to improve the survival of patients with large hepatocellular carcinoma (HCC). To date, the safety and feasibility of laparoscopic right hemihepatectomy via the anterior approach (ALRH) for patients with large HCC remains unclear; thus, we compared short-term and long-term outcomes between ALRH and open right hemihepatectomy via the anterior approach (AORH). METHODS 161 patients with HCC who met the inclusion and exclusion criteria in our department were enrolled in this study between January 2015 and August 2018. Perioperative and oncological outcomes were compared using propensity score matching analysis (PSM). RESULTS There were 45 patients in the ALRH group and 116 patients in the AORH group. After 1:3 PSM, 40 ALRH patients and 95 AORH patients were well matched. The intraoperative time was longer in the ALRH group than in the AORH group after PSM (median, 297.5 vs. 205 min, P < 0.001). However, ALRH led to less intraoperative blood loss than AORH after PSM (median, 265 vs. 350 ml, P = 0.049). The rates of overall complications (12.5% vs. 30.5%, P = 0.028) in the ALRH group were significantly lower than those in the AORH group after PSM. Moreover, the survival outcomes were equivalent between the two groups with regard to 1-, 3-, and 5-year overall survival rates (P = 0.698) and disease-free survival rates (P = 0.510). CONCLUSION ALRH could be safe and feasible for some patients with large HCCs (5-10 cm) when performed by experienced surgeons, and it had superior perioperative outcomes and equivalent oncological outcomes to AORH.
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Asencio JM, González J, Herranz-Amo F, Hernández-Fernández C. Retrohepatic inferior vena cava control through an anterior approach in cases of renal cell carcinoma with level IIIa tumor thrombus: Step-by-step description. Actas Urol Esp 2021; 45:587-596. [PMID: 34697007 DOI: 10.1016/j.acuroe.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level IIIa tumor thrombus. PATIENTS AND METHODS Initial series of 6 cases presenting RCC and level IIIa tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018-2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. RESULTS Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14-22 min). Mean estimated blood loss was 325 cc (range: 250-400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0-2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5-11). CONCLUSIONS The RIVCA technique applied to cases of RCC and level IIIa tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level IIIa tumor thrombus.
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Affiliation(s)
- J M Asencio
- Sección de Cirugía Hepato-Bilio-Pancreática, Unidad de Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - J González
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Unidad de Trasplante Renal, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - F Herranz-Amo
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Unidad de Trasplante Renal, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - C Hernández-Fernández
- Universidad Complutense de Madrid, Madrid, Spain; Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Asencio JM, González J, Herranz-Amo F, Hernández-Fernández C. Retrohepatic inferior vena cava control through an anterior approach in cases of renal cell carcinoma with level iiia tumor thrombus: Step-by-step description. Actas Urol Esp 2021; 45:S0210-4806(21)00101-7. [PMID: 34334240 DOI: 10.1016/j.acuro.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level iiia tumor thrombus. PATIENTS AND METHODS Initial series of 6 cases presenting RCC and level iiia tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018-2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. RESULTS Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14-22min). Mean estimated blood loss was 325cc (range: 250-400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0-2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5-11). CONCLUSIONS The RIVCA technique applied to cases of RCC and level iiia tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level iiia tumor thrombus.
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Affiliation(s)
- J M Asencio
- Sección de Cirugía Hepato-Bilio-Pancreática, Unidad de Trasplante Hepático, Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España.
| | - J González
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España; Unidad de Trasplante Renal, Hospital Universitario Gregorio Marañón, Madrid, España
| | - F Herranz-Amo
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España; Unidad de Trasplante Renal, Hospital Universitario Gregorio Marañón, Madrid, España
| | - C Hernández-Fernández
- Universidad Complutense de Madrid, Madrid, España; Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastases: review of the literature. Clin Exp Hepatol 2021; 7:125-133. [PMID: 34295978 PMCID: PMC8284168 DOI: 10.5114/ceh.2021.106521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/26/2021] [Indexed: 02/08/2023] Open
Abstract
The liver is considered as one of the most common sites of metastasis and a key determining factor of survival in patients with isolated colorectal liver metastasis (CRLM). For longer survival of patients, surgical resection is the only available option. Especially in CRLM bilobar patients, to achieve R0 resection, maintaining an adequate volume of the future liver remnant (FLR) is the main technical challenge to avoid post-hepatectomy liver failure (PHLF). As standard procedures in the treatment of patients with severe metastatic liver disease, techniques such as portal vein embolization/portal vein ligation (PVE/PVL) accompanied by two-stage hepatectomy (TSH) have been introduced. These methods, however, have drawbacks depending on the severity of the disease and the capacity of the patient to expand the liver remnant. Eventually, implementation of the novel ALPPS technique ignited excitement among the community of hepatobiliary surgeons because ALPPS challenged the idea of unrespectability and extended the limit of liver surgery and it was reported that FLR hypertrophy of up to 80% was induced in a shorter time than PVL or PVE. Nonetheless, ALPPS techniques caused serious concerns due to the associated high morbidity and mortality levels of up to 40% and 15% respectively, and PHLF and bile leak are critical morbidity- and mortality-related factors. Carefully establishing the associated risk factors of ALPPS has opened up a new dimension in the field of ALPPS technique for improved surgical outcome by carefully choosing patients. The benefit of ALPPS technique is enhanced when performed for young patients with very borderline remnant volume. Adopting ALPPS technical modifications such as middle hepatic vein preservation, surgical management of the hepatoduodenal ligament, the anterior approach and partial ALPPS may lead to the improvement of ALPPS surgical performance. Research findings to validate the translatability of ALPPS’ theoretical advantages into real survival benefits are scarce.
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Xu X, Yang L, Chen W, He M. Transhepatic hilar approach for Bismuth types III and IV perihilar cholangiocarcinoma with long-term outcomes. J Int Med Res 2021; 49:3000605211008336. [PMID: 33983055 PMCID: PMC8127775 DOI: 10.1177/03000605211008336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective To compare the outcomes of the transhepatic hilar approach and conventional approach for surgical treatment of Bismuth types III and IV perihilar cholangiocarcinoma. Methods We retrospectively reviewed the medical records of 82 patients who underwent surgical resection of Bismuth types III and IV perihilar cholangiocarcinoma from 2008 to 2016. The transhepatic hilar approach and conventional approach was used in 36 (43.9%) and 46 (56.1%) patients, respectively. Postoperative complications and overall survival were compared between the two approaches. Results Similar clinical features were observed between the patients treated by the conventional approach and those treated by the transhepatic hilar approach. The transhepatic hilar approach was associated with less intraoperative bleeding and a lower percentage of Clavien grade 0 to II complications than the conventional approach. However, the transhepatic hilar approach was associated with a higher R0 resection rate and better overall survival. Multivariate analysis showed that using the transhepatic hilar approach, the Memorial Sloan-Kettering Cancer Center classification, and R0 resection were independent risk factors for patient survival. Conclusion The transhepatic hilar approach might be the better choice for surgical resection of Bismuth types III and IV perihilar cholangiocarcinoma because it is associated with lower mortality and improved survival.
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Affiliation(s)
- Xinsen Xu
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Linhua Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Wei Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Min He
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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Tzedakis S, Jeddou H, Boudjema K, Gaujoux S. Hanging and modified liver hanging maneuver. J Visc Surg 2020; 157:511-518. [PMID: 32912751 DOI: 10.1016/j.jviscsurg.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S Tzedakis
- Department Digestive Surgery, Cochin Hospital, AP-HP, 75014 Paris, France; University Paris Descartes, 75005 Paris, France
| | - H Jeddou
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France; Rennes University, Rennes, France
| | - K Boudjema
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France; Rennes University, Rennes, France
| | - S Gaujoux
- Department Digestive Surgery, Cochin Hospital, AP-HP, 75014 Paris, France; Department Digestive, HPB Surgery and liver transplantation, Hôpital Pitié Salpétriere, AP-HP, 75013 Paris, France; Sorbonne Université, 75004 Paris, France.
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Jia C, Ge K, Xu S, Liu L, Weng J, Chen Y. Selective occlusion of the hepatic artery and portal vein improves liver hypertrophy for staged hepatectomy. World J Surg Oncol 2019; 17:167. [PMID: 31590665 PMCID: PMC6781355 DOI: 10.1186/s12957-019-1710-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/10/2019] [Indexed: 12/23/2022] Open
Abstract
Background To evaluate the safety and feasibility of selective occlusion of the hepatic artery and portal vein (SOAP) for staged hepatectomy (SOAPS) in patients with hepatocellular carcinoma (HCC) Methods From December 2014 to August 2018, 9 patients with unresectable HCC were chosen to undergo SOAPS. SOAP without liver partition was performed in the first stage. The second stage was performed when future liver remnant (FLR) was equal to or bigger than 40% of the standard liver volume (SLV). The growth rate of FLR, perioperative outcomes, and survival data was recorded. Results In the first stage, all the 9 patients completed SOAP. Two cases received radiological interventional method and 7 cases received open operation. None of them developed liver failure and died following SOAP. After SOAP, FLR increased 145.0 ml (115.0 to 210 ml) and 37.1% (25.6 to 51.7%) on average. The average time interval between the two stages was 14.1 days (8 to 18 days). In the second stage, no in-hospital deaths occurred after SOAPS. One patient suffered from liver failure after SOAPS, and artificial liver support was adopted and his total bilirubin level returned to normal after postoperative day 35. The alpha-fetoprotein level of 8 patients reduced to normal within 2 months after SOAPS. Among 9 patients, 5 patients survived, 4 patients died of intrahepatic recurrence, lung metastasis, or bone metastasis. In the 5 survived cases, bone metastasis and intrahepatic recurrence were found in 1 patient, intrahepatic recurrence was found in another patient, and the remaining 3 patients were free of recurrence. The median disease-free survival time and overall survival time were 10.4 and 13.9 months, respectively. Conclusion SOAP can facilitate rapid and sustained FLR hypertrophy, and SOAPS is safe and effective in patients with unresectable HCC.
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Affiliation(s)
- Changku Jia
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, No. 261, Huansha Road, Hangzhou, 310006, China.
| | - Ke Ge
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, No. 261, Huansha Road, Hangzhou, 310006, China
| | - Sunbing Xu
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, No. 261, Huansha Road, Hangzhou, 310006, China.
| | - Ling Liu
- Department of Hepatobiliary Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, No. 261, Huansha Road, Hangzhou, 310006, China
| | - Jie Weng
- Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical College, Haikou, 570102, China
| | - Youke Chen
- Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical College, Haikou, 570102, China
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Ariizumi SI, Nanashima A, Yamamoto M. Anterior approach in right hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 25:351-352. [PMID: 29974674 DOI: 10.1002/jhbp.567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Nanashima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Nanashima A, Ariizumi SI, Yamamoto M. Right anatomical hepatectomy: pioneers, evolution, and the future. Surg Today 2019; 50:97-105. [DOI: 10.1007/s00595-019-01809-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
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Donadon M, Mimmo A, Cosola D, Terrone A, Procopio F, Del Fabbro D, Cimino M, Viganò L, Torzilli G. Hepatectomy with or without the thoraco-abdominal approach: impact on perioperative outcome. HPB (Oxford) 2018; 20:752-758. [PMID: 29615370 DOI: 10.1016/j.hpb.2018.02.639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatectomy using the thoraco-abdominal approach (TAA) compared to the abdominal approach (AA) remains under debate. This study assessed the perioperative outcomes of patients operated with or without TAA. METHODS 1:1 propensity score-matched analysis was applied in 744 patients operated between 2007 and 2013, identifying 246 patients who underwent hepatectomy with TAA compared to 246 patients with AA. These groups were matched for demographics, liver disease, comorbidity, tumor features, and extent of resection. Rates of morbidity and mortality were the study endpoints. RESULTS The rates of morbidity or mortality were not different. With the TAA length of the operations (P = 0.002), length of the Pringle maneuver (P = 0.012), and rate of blood transfusions (P = 0.041) were significantly different. Hospital stay was similar. Independent significant prognostic factors for adverse perioperative outcome were: renal comorbidity (OR = 2.7; P = 0.001), extent of the resection (OR = 3.7; P = 0.001), and increased BILCHE score (OR = 2.4; P = 0.002). CONCLUSIONS Hepatectomy using the TAA was not associated with adverse perioperative outcome. The associations with length of operation, Pringle maneuver and blood transfusions may have reflected the complexity of the tumor presentation rather than the technical approach.
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Affiliation(s)
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
| | - Antonio Mimmo
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Davide Cosola
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Alfonso Terrone
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Fabio Procopio
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Daniele Del Fabbro
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Matteo Cimino
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Luca Viganò
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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Petrovski S, Karakolevska-Ilova M, Simeonovska-Joveva E, Serafimov A, Adzi-Andov L, Dimitrova V. Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases. Open Access Maced J Med Sci 2018; 6:1046-1051. [PMID: 29983799 PMCID: PMC6026431 DOI: 10.3889/oamjms.2018.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%. AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients. METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases. CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.
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Affiliation(s)
- Stefan Petrovski
- Clinical Hospital Shtip, Surgery, Ljuben Ivanov bb, Shtip, Republic of Macedonia
| | | | | | | | | | - Violeta Dimitrova
- Clinic of General and Hepato-Pancreatic Surgery, University Hospital "Aleksandrovska", Sofia, Bulgaria
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Efficacy of Transhepatic Anterior Approach to the Inferior Vena Cava for Malignant Pheochromocytoma Invading Right Posterior Lobe of the Liver: A Case Report. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00130.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction:
The anterior approach to the inferior vena cava (IVC) by the liver hanging maneuver is effective in resecting large retrohepatic tumors without mobilizing the right lobe.
Case presentation:
A 50-year-old man was referred to our hospital with a diagnosis of pheochromocytoma. He had severe congestive heart failure and cardiac ejection fraction was 15%. Abdominal magnetic resonance imaging (MRI) and ultrasonography (US) showed an adrenal mass about 80 mm in diameter. The tumor-infiltrated posterior segment of the right hepatic lobe and tumor were widely attached to the IVC. After treatment of congestive heart failure with conservative therapy, surgery was planned. Right adrenectomy and right hepatectomy were performed, the latter using the liver hanging maneuver to avoid mobilizing the right lobe, and we were able to minimize blood pressure fluctuations and perform the operation safely. The histopathologic diagnosis was malignant pheochromocytoma.
Conclusions:
We performed right hepatectomy without mobilizing the right lobe by the liver hanging maneuver and minimized stimulation of the tumor. We could perform the operation safely using the liver hanging maneuver, which seems effective in such cases.
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Tang JX, Li JJ, Weng RH, Liang ZM, Jiang N. Anterior vs conventional approach right hepatic resection for large hepatocellular carcinoma: A systematic review and meta-analysis. World J Gastroenterol 2017; 23:7917-7929. [PMID: 29209133 PMCID: PMC5703921 DOI: 10.3748/wjg.v23.i44.7917] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach. METHODS We comprehensively performed an electronic search of PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) or controlled clinical trials (CCTs) published between January 2000 and May 2017 concerning the anterior approach (AA) and the conventional approach (CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model. RESULTS This analysis included 2297 patients enrolled in 16 studies (3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference = -255.21; 95% confidence interval (95%CI): -371.3 to -139.12; P < 0.0001], intraoperative blood transfusion [odds ratio (OR) = 0.42; 95%CI: 0.29-0.61; P < 0.0001], mortality (OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity (OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrence rate (OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival (hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival (HR = 0.67; 95%CI: 0.58-0.79; P < 0.0001) than those in the CA group. CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.
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Affiliation(s)
- Jian-Xin Tang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
| | - Jin-Jun Li
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
| | - Rui-Hui Weng
- Department of Neurology, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
| | - Zi-Ming Liang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
| | - Nan Jiang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
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Beppu T, Imai K, Okuda K, Eguchi S, Kitahara K, Taniai N, Ueno S, Shirabe K, Ohta M, Kondo K, Nanashima A, Noritomi T, Shiraishi M, Takami Y, Okamoto K, Kikuchi K, Baba H, Fujioka H. Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi-institutional propensity score-matching study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:127-136. [PMID: 28181419 DOI: 10.1002/jhbp.431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This multi-institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH-HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH). METHODS From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH-HM (n = 104) and CRH (n = 202). RESULTS After one-to-one propensity score-matched analysis, 72 ARH-HM and 72 CRH patients presented comparable background factors. Patients in the ARH-HM group demonstrated significantly less intraoperative blood loss (480 vs. 1,242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5-year overall survival rate was significantly better in the ARH-HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence-free and overall survival of the ARH-HM group was significantly greater than those of the CRH group. CONCLUSION In comparison with CRH, ARH-HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm.
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Affiliation(s)
- Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Koji Okuda
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Kurume University, Kurume, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | | | - Shinichi Ueno
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhiro Kondo
- Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan
| | - Atsushi Nanashima
- Division of Surgical Oncology and Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoaki Noritomi
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masayuki Shiraishi
- First Department of Surgery, Faculty of Medicine, University of the Ryukyu, Okinawa, Japan
| | - Yuko Takami
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kohji Okamoto
- Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Ken Kikuchi
- Medical Quality Management Center, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hikaru Fujioka
- Clinical Research Center and Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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Ramachandra C, Vikas S, Krishnamurthy S, Ramesh S, Appaji L, Kumar RV. Extended Right Hepatectomy by Liver Hanging Maneuver in an Infant with Hepatoblastoma. Indian J Surg Oncol 2017; 8:411-413. [DOI: 10.1007/s13193-016-0555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022] Open
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Cawich SO, Thomas DAW, Ragoonanan V, Ramjit C, Narinesingh D, Naraynsingh V, Pearce N. Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report. Mol Clin Oncol 2017; 7:687-692. [PMID: 28856002 DOI: 10.3892/mco.2017.1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/22/2017] [Indexed: 12/16/2022] Open
Abstract
Liver resections are safe when performed by specialized hepatobiliary teams. However, complex liver resections are accompanied by significant perioperative risk and they may require modifications of the conventional surgical techniques. We herein report the case of a 54-year-old male patient who underwent an extended right liver resection with en bloc resection and reconstruction of the inferior vena cava. For this complex resection, a modification of the standard operative technique was required. A modified hanging manoeuvre was performed using two 19Fr nasogastric tubes outside the traditional avascular plane to facilitate resection. This modification of the hanging manoeuvre was proven to be feasible and safe, and it is recommended for inclusion in the armamentarium of hepatobiliary surgeons when complex resections are required.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Dexter A W Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Vindra Ragoonanan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Chunilal Ramjit
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Dylan Narinesingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, The Republic of Trinidad and Tobago
| | - Neil Pearce
- Hepatobiliary Division, Department of Surgery, Southampton General Hospital, SO16 6YD Southampton, UK
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23
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Goja S, Singh MK, Chaudhary RJ, Soin AS. Robotic-assisted right hepatectomy via anterior approach for intrahepatic cholangiocarcinoma. Ann Hepatobiliary Pancreat Surg 2017; 21:80-83. [PMID: 28567451 PMCID: PMC5449368 DOI: 10.14701/ahbps.2017.21.2.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/04/2017] [Accepted: 02/11/2017] [Indexed: 01/18/2023] Open
Abstract
Major hepatic resection, especially right hepatectomy, has been successfully performed by specialized hepatobiliary centers using the robotic platform with low morbidity, conversion rates and outcomes comparable to laparoscopic and open surgery. The authors report a case of robotic-assisted right hepatectomy done for intrahepatic cholangiocarcinoma using anterior approach, after right portal vein embolisation for future liver remnant volume enhancement.
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Affiliation(s)
- Sanjay Goja
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, India
| | - Manoj K Singh
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, India
| | - Rohan Jagat Chaudhary
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, India
| | - Arvinder S Soin
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, India
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Jabir MA, Hamza HM, Fakhry H, Amira G, Hatano E, Uemoto S. Anterior Versus Conventional Approach for Resection of Large Right Lobe Hepatocellular Carcinoma. J Gastrointest Cancer 2017; 48:25-30. [PMID: 27506210 DOI: 10.1007/s12029-016-9865-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE In this study, we aim to report the efficacy of using the anterior approach (AA) versus the conventional approach (CA), in surgical resection for large hepatocellular carcinoma (HCC) (≥7 cm) of the right hepatic lobe in terms of surgical and long-term outcomes. MATERIALS AND METHODS Between 2000 and 2006, 138 consecutive patients who underwent hepatic resection with curative intent for large right lobe HCC ≥7 cm were identified from a retrospective database. The 40 patients who had AA were compared with the remaining 98 patients who had CA. Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. RESULTS There was no significant difference between the two groups as regards clinical, laboratory, and pathological parameters. The operative results had shown a comparable proportion of patients who experienced massive operative blood loss and postoperative complications in the two groups. The AA group had a lower recurrence rate (P = 0·015), better disease-free survival (DFS) (P = 0·001), and overall survival than the CA group. Our study identified that AA is a prognostic factor of both overall survival and disease-free survival for large HCC ≥7 cm. CONCLUSION The AA is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the CA.
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Affiliation(s)
- Murad A Jabir
- Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt
| | - Hesham M Hamza
- Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt
| | - Hussein Fakhry
- Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt.
| | - Gamal Amira
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
BACKGROUND With the recent advances in oncological hepatic surgery, major liver resections became more widely utilized procedures. The era of modern hepatic surgery witnessed improvements in patients care in preoperative, intraoperative and postoperative aspects. This significantly improved surgical outcomes regarding morbidity and mortality. This review article focuses on the recent advances in oncological hepatic surgery. DATA SOURCES This review includes only data from peer-reviewed articles and journals. PubMed database was utilized as the primary source of the supporting literature to this review article on the latest advances in oncological hepatic surgery. Comprehensive and high sensitivity search strategies were performed to search related studies exhaustively up till June 2016. We critically and independently assessed over 50 recent publications written on this topic according to the selection criteria and quality assessment standard. We paid particular attention to the studies published in high impact journals that address the use of the surgical techniques mentioned in the articles in well-known institutions. RESULTS Among all utilized approaches aiming at the preoperative assessment of the liver function, Child-Turcotte-Pugh classification remains the most reliable tool correlating with survival outcome. Although the primary radiological tools including ultrasonography, computed tomography and magnetic resonance imaging remain on top of the menu of tests utilized in assessment of focal hepatic lesions, intraoperative ultrasonography projects to be a powerful additional tool in terms of sensitivity and specificity compared to the other conventional techniques in assessment of the liver in the operative setting, a procedure that can change the surgical strategy in 27.2% of the cases and consequently improve the oncological surgical outcome. In addition to the conventional surgical techniques of liver resection and portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy "ALPPS" projects to be an alternative option in patients with marginally resectable tumors with an inadequate size of future liver remnant with an accepted surgical oncological outcome. CONCLUSIONS Considering the clinicopathological nature of hepatic lesions, the comprehensive assessment and proper choice of the liver resection technique in highly selected patients is associated with improved surgical oncological outcome. Patients with underlying marginal future liver remnant volumes can now safely benefit from a wider range of surgical intervention, a breakthrough that significantly improved morbidity and mortality in this group of patients.
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Affiliation(s)
- Ahmed I Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue BX7375 CLINICAL SCIENCE CNTR Madison, WI 53792-7375, USA.
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The liver hanging maneuver in laparoscopic liver resection: a systematic review. Surg Today 2017; 48:18-24. [PMID: 28365891 DOI: 10.1007/s00595-017-1520-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Laparoscopic surgery has gained the acceptance of the hepatobiliary surgical community and expert teams are now advocating major laparoscopic liver resections (LLRs). In this setting, the liver hanging maneuver (LHM) has been described in numerous series. We conducted a systematic review to investigate the effectiveness of the LHM in LLR. METHODS We performed an electronic literature search using PubMed, EMBASE, and COCHRANE databases. The final search was carried out in December, 2015. RESULTS We found 11 articles describing a collective total of 104 surgical procedures that were eligible for this study. Laparoscopic LHM was used in LLR for both benign and malignant conditions, and also in living donor liver transplantation (LDLT). The LHM was used mainly in right hepatectomy and only two authors reproduced the original LHM. We investigated the intraoperative parameters, preservation of postoperative liver function, and oncological outcomes. The clear benefit of using the LHM in LLR is for better identification of the parenchymal transection plane with less blood loss. The other benefits of LHM could not be corroborated by solid data on its positive value. CONCLUSIONS In view of the data published in the literature, our findings are not strong enough to support the systematic use of LHM in LLR.
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Anatomy of the retrohepatic tunnel in a Chinese population and its clinical application in liver surgery. Sci Rep 2017; 7:44977. [PMID: 28322287 PMCID: PMC5359567 DOI: 10.1038/srep44977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 02/20/2017] [Indexed: 02/08/2023] Open
Abstract
Liver hanging maneuver (LHM) is an important technique in liver surgery. However, applied anatomy of the retrohepatic tunnel for the surgical approach in Chinese population needs further study. In this study, to explore the basic anatomy of retrohepatic tunnel and its clinical application in a Chinese population, a total of 32 formalin-fixed cadavers were dissected, related parameters were measured, and their clinical applications were discussed. The length of the retrohepatic tunnel was (60.6 ± 9.9) mm. The width of the retrohepatic tunnel superior opening was (13.8 ± 3.9) mm. The width of the retrohepatic tunnel inferior opening was (15.2 ± 7.4) mm. The hepatic short vessels were distributed along the middle and lower 1/3 of hepatic inferior vena cava (HIVC), with a slight predominance on its left wall. A few hepatic short vessels were distributed along the upper 1/3 of the HIVC. We concluded: the anatomy of the retrohepatic tunnel provides a basis for use of LHM in liver surgery; more hepatic short vessels from hepatic caudate lobe can be preserved via right approach. The retrohepatic tunnel can be used as a good surgical approach in liver surgery; its application also has important significance in laparoscopic minimally invasive liver surgery.
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Cai LX, Wei FQ, Yu YC, Cai XJ. Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy? J Zhejiang Univ Sci B 2016; 17:712-21. [PMID: 27604863 DOI: 10.1631/jzus.b1600180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The liver hanging maneuver (LHM) is rarely applied in laparoscopic right hepatectomy (LRH) because of the difficulty encountered in retrohepatic tunnel (RT) dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study's aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. METHODS Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. RESULTS The median age of patients was 58 (range, 51-65) years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 (40-150) mm. The median operative time was 320 (282-358) min with a median blood loss of 200 (200-600) ml. Laparoscopic LHM was achieved in a median of 31 (21-62) min, and the median postoperative hospital stay was 14 (9-16) d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. CONCLUSIONS The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.
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Affiliation(s)
- Liu-Xin Cai
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Fang-Qiang Wei
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Yi-Chen Yu
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xiu-Jun Cai
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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Zhou YM, Sui CJ, Zhang XF, Li B, Yang JM. Anterior approach combined with infrahepatic inferior vena cava clamping right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled trial. Medicine (Baltimore) 2016; 95:e4159. [PMID: 27399136 PMCID: PMC5058865 DOI: 10.1097/md.0000000000004159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The anterior approach (AA) technique has been reported to provide better operative and survival outcomes compared with the conventional approach for large right hepatocellular carcinoma (HCC) resection. However, this technique runs the risk of massive retrograde bleeding from the right hepatic vein or middle hepatic vein at the deeper plane of parenchymal transection. This study was designed to evaluate the efficacy of AA combined with infrahepatic inferior vena cava (IVC) clamping on the perioperative outcomes in patients undergoing right hepatic resection for large HCC in randomized clinical trial settings. METHODS A total of 101 patients undergoing right hepatic resection for large HCC were randomized to receive AA combined with infrahepatic IVC clamping (group A, n = 50), or AA alone (group B, n = 51). RESULTS The total blood loss (423 ± 154 vs 757 ± 338 mL; P = 0.001), blood loss during liver transection (272 ± 96 vs 563 ± 144 mL; P = 0.001), and intraoperative blood transfusion requirements (12.0% vs 29.4%; P = 0.031) were significantly less in group A patients compared with group B patients. There was no IVC clamping-associated morbidity in group A. CONCLUSION AA combined with infrahepatic IVC clamping for large right HCC resection is a safe, feasible, and effective technique in reducing intraoperative blood loss.
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Affiliation(s)
- Yan-Ming Zhou
- Department of Hepatobiliary and Pancreatovascular Surgery, First affiliated Hospital of Xiamen University
| | - Cheng-Jun Sui
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Feng Zhang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Bin Li
- Department of Hepatobiliary and Pancreatovascular Surgery, First affiliated Hospital of Xiamen University
| | - Jia-Mei Yang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
- Correspondence: Jia-Mei Yang, Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China (e-mail: )
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Vennarecci G, Grazi GL, Sperduti I, Busi Rizzi E, Felli E, Antonini M, D'Offizi G, Ettorre GM. ALPPS for primary and secondary liver tumors. Int J Surg 2016; 30:38-44. [DOI: 10.1016/j.ijsu.2016.04.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/24/2016] [Accepted: 04/05/2016] [Indexed: 12/16/2022]
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Wong WM, Cheung CC, Mak CF. Early experience of transarterial chemoembolization and stereotactic body radiotherapy as neoadjuvant therapy in treating solitary right-lobe hepatocellular carcinoma greater than 10 cm. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Wai-Man Wong
- Department of Surgery; Tuen Mun Hospital; Hong Kong
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Higuchi R, Yazawa T, Uemura S, Yamamoto M. Anterior approach for perihilar cholangiocarcinoma (with video). J Surg Res 2015; 202:71-6. [PMID: 27083950 DOI: 10.1016/j.jss.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/11/2015] [Accepted: 12/10/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND To evaluate the significance of the anterior approach without the Pringle maneuver during right hepatectomies with caudate lobectomies for perihilar cholangiocarcinomas (PHCs). MATERIALS AND METHODS From January 2011 to 2015, 25 consecutive patients underwent right hepatectomies with caudate lobectomies using the anterior approach without the Pringle maneuver for PHC (group A). Between 2003 and 2011, 44 patients were operated on for PHC using the classic right approach (group B). We compared the groups with respect to the patients' characteristics and the short-term surgical outcomes. RESULTS Group A had significantly lower postoperative mean maximum levels of aspartate aminotransferase (294 U/L versus 453 U/L; P = 0.044), lower frequencies of maximum aspartate aminotransferase or alanine aminotransferase levels that exceeded 500 U/L (8.0% versus 32%; P = 0.036), shorter total Pringle maneuver times (7.1 versus 46.3 min; P < 0.001), lower Pringle maneuver frequencies (0.76 maneuvers versus 5.1 maneuvers; P < 0.001), less bleeding (1237 mL versus 1646 mL; P = 0.025), and shorter postoperative systemic inflammatory response syndrome durations (2.3 h versus15.4 h; P < 0.001) compared with group B. CONCLUSIONS This approach can be performed safely, and it seems to limit the hemodynamic disturbance of the remnant left liver.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
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The anterior hanging-approach improves postoperative course after right hepatectomy in patients with colorectal liver metastases. Results of a prospective study with propensity-score matching comparison. Eur J Surg Oncol 2015; 42:176-83. [PMID: 26710993 DOI: 10.1016/j.ejso.2015.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 11/01/2015] [Accepted: 11/09/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To establish the role of the anterior approach with liver hanging maneuver for right hepatectomy in patients with colorectal liver metastases (CRLM). SUMMARY BACKGROUND DATA The indications for hepatectomy in patients with CRLM are expanding. The liver remnant must be protected to avoid morbidity. METHODS We prospectively enrolled all patients with the diagnosis of CRLM requiring right hepatectomy from 2009 to 2012. In all cases right hepatectomy with an anterior-hanging maneuver approach was attempted. We compared the group of patients who underwent this procedure with a group of patients who had previously undergone a conventional right hepatectomy. To minimize selection bias, propensity score matching was performed, based on baseline patient characteristics. RESULTS A right hepatectomy was planned in 57 cases. The anterior-hanging approach was feasible in 85% of cases. Overall morbidity was similar. In-hospital mortality due to hepatic insufficiency was 2.3% in anterior-hanging group compared to 9% in the conventional group (p = 0.30). The incidence of ascites was significantly greater in the conventional group (AH: 18% vs Conv: 54%; p = 0.002), and hospital stay was longer (AH: 10.9 ± 5.7 vs Conv: 14.4 ± 8.1 days; p = 0.05). Bilirubin levels were significantly lower in anterior-hanging group in day 1 and 3. There were no differences on recurrence nor survival. CONCLUSIONS The anterior-hanging approach for right hepatectomy in patients with CRLM can be used safely with a high feasibility rate. Its use contributes to improve postoperative course.
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Thng Y, Tan JKH, Shridhar IG, Chang SKY, Madhavan K, Kow AWC. Outcomes of resection of giant hepatocellular carcinoma in a tertiary institution: does size matter? HPB (Oxford) 2015; 17:988-93. [PMID: 26334002 PMCID: PMC4605337 DOI: 10.1111/hpb.12479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The surgical management of giant hepatocellular carcinoma (G-HCC), or HCC of ≥10 cm in diameter, remains controversial. The aim of this study was to compare the outcomes of surgical resection of, respectively, G-HCC and small HCC (S-HCC), or HCC measuring <10 cm. METHODS A retrospective review of all patients (n = 86) diagnosed with HCC and submitted to resection in a tertiary hospital during the period from January 2007 to June 2012 was conducted. Overall survival (OS), recurrence rates and perioperative mortality at 30 days were compared between patients with, respectively, G-HCC and S-HCC. Prognostic factors for OS were analysed. RESULTS The sample included 23 patients with G-HCC (26.7%) and 63 with S-HCC (73.3%) based on histological tumour size. Patient demographics and comorbidities were comparable. Median OS was 39.0 months in patients with G-HCC and 65.0 months in patients with S-HCC (P = 0.213). Although size did not affect OS in this cohort, the presence of satellite lesions [hazard ratio (HR) 3.70, P = 0.012] and perioperative blood transfusion (HR 2.85, P = 0.015) were negative predictors for OS. CONCLUSIONS Surgical resection of G-HCC provides OS comparable with that after resection of S-HCC.
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Affiliation(s)
- Yongxian Thng
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore
| | - Jarrod K H Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Iyer G Shridhar
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore
| | - Stephen K Y Chang
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore
| | - Krishnakumar Madhavan
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore
| | - Alfred W C Kow
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore
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Cawich SO, Thomas D, Ragoonanan V, Naraynsingh V. The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report. Int J Surg Case Rep 2015; 16:52-5. [PMID: 26413923 PMCID: PMC4643337 DOI: 10.1016/j.ijscr.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Angiosarcomas arising in the liver are rare tumours in the Western world. We report a case of a locally advanced primary hepatic angiosarcoma and also describe the manoeuvres used to achieve operative resection. PRESENTATION OF A CASE A 52-year old woman presented with vague right upper quadrant pain. Abdominal imaging revealed a heterogenous tumour in the right liver measuring 15centimetres in maximal diameter. Although the tumour was deemed to be resectable, there was free fluid in the right paracolic gutter suggestive of rupture. Intra-operatively, the peritoneal cavity was noted to be free of metastatic disease. However, tumour was adherent to the diaphragm precluding traditional mobilization of the liver. Therefore, a modified hanging manoeuvre was performed using a nasogastric tube. This allowed controlled mobilization of the right liver, parenchymal transection and en-bloc resection of the diaphragm with good hemostasis. Histologic examination revealed a primary angiosarcoma with uninvolved margins. DISCUSSION When they occur, primary hepatic angiosarcomas are most often locally advanced. Nevertheless, surgeons should be aggressive in the pursuit of complete resections because this is the only therapeutic modality that has been shown to have a survival advantage. CONCLUSION Hepatobiliary surgeons should keep the hanging manoeuver in their armamentarium when performing complex liver resections for locally advanced angiosarcomas.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago.
| | - Dexter Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Vindra Ragoonanan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
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Chan KM, Wang YC, Wu TH, Lee CF, Wu TJ, Chou HS, Yu MC, Lee WC. The Preference for Anterior Approach Major Hepatectomy: Experience Over 3 Decades and a Propensity Score-Matching Analysis in Right Hepatectomy for Hepatocellular Carcinoma. Medicine (Baltimore) 2015; 94:e1385. [PMID: 26313778 PMCID: PMC4602929 DOI: 10.1097/md.0000000000001385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical treatment for primary hepatocellular carcinoma (HCC) has progressed enormously over time. The aim of this study was to analyze the evolution of surgical techniques and outcomes of patients undergoing major right hepatectomy (RH) over the last few decades.A retrospective review of 557 consecutive patients who had undergone RH for HCC between January 1982 and December 2011 was performed. Patients were categorized into subgroups and analyzed according to period and surgical approach to hepatectomy. Based on a propensity score-matching model, the surgical approach in patients in the second period was also analyzed in terms of anterior approach (AA) and conventional approach (CA)-RH.Tumor factors remained the most important prognostic factors related to postoperative HCC recurrence throughout the 2 periods examined in this study. Comparison of patients selected by a propensity score-matching model showed that AA-RH led to significantly better outcomes including recurrence-free survival (RFS) (P = 0.011) and overall survival (OS) (P = 0.012) in patients with HCC as compared with CA-RH. The 5-year RFS and OS were 33.4% and 52.2% after AA-RH, and 21.0% and 36.5% after CA-RH.Major hepatectomy has evolved into a safe procedure that can be performed with confidence. RH by an AA has shown several advantages over CA-RH, and can thus be recommended as the standard procedure for liver resection in patients who require right hepatectomy.
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Affiliation(s)
- Kun-Ming Chan
- From the Division of Liver and Transplantation Surgery, Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Nanashima A, Nagayasu T. Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today 2015; 46:398-404. [PMID: 25877717 DOI: 10.1007/s00595-015-1166-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 03/22/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the clinical application and usefulness of the liver hanging maneuver (LHM), proposed by Belghiti, for major hepatectomy, including its (1) historical development, (2) usefulness and application and (3) advantages and disadvantages, by reviewing the English literature published during the period 2001-2014. RESULTS In major hepatic transection via the anterior approach, the deep area of transection around the vena cava is critical with regard to bleeding during right hemi-hepatectomy. Belghiti and other investigators identified avascular spaces that are devoid of short hepatic veins at the front of the vena cava and behind the liver. Forceps can be inserted into this space easily and then maneuvered to lift the liver using hanging tape. This procedure, termed LHM significantly reduces intraoperative blood loss and the transection time during right hemi-hepatectomy. LHM has been used in various anatomical hepatectomy procedures worldwide, including laparoscopic hepatectomy. The use of LHM markedly improves the amount of intraoperative blood loss, operative time and postoperative outcome. CONCLUSIONS We conclude that the application of LHM is an important development in the field of liver surgery, although a further evaluation of its true impact on clinical outcomes is necessary.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501, Japan.
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 8528501, Japan
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Complex liver resections for colorectal metastases: are they safe in the low-volume, resource-poor Caribbean setting? Case Rep Surg 2015; 2015:570968. [PMID: 25713743 PMCID: PMC4332977 DOI: 10.1155/2015/570968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/21/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems. Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment. Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available.
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Li L, Wang HQ, Wang Q, Yang J, Yang JY. Anterior vs conventional approach hepatectomy for large liver cancer: A meta-analysis. World J Gastroenterol 2014; 20:17235-17243. [PMID: 25493040 PMCID: PMC4258596 DOI: 10.3748/wjg.v20.i45.17235] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/01/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical outcomes and safety of anterior- and conventional-approach hepatectomy for patients with large liver tumors.
METHODS: PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models.
RESULTS: Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02).
CONCLUSION: AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy.
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Nanashima A, Abo T, Takagi K, Arai J, To K, Kunizaki M, Hidaka S, Takeshita H, Sawai T, Nagayasu T. Prognostic influence of the liver hanging maneuver for patients with hepatobiliary malignancies who underwent hepatic resections. Eur J Surg Oncol 2014; 40:1540-9. [DOI: 10.1016/j.ejso.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/14/2014] [Accepted: 06/26/2014] [Indexed: 12/21/2022] Open
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41
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Chau GY. Resection of hepatitis B virus-related hepatocellular carcinoma: Evolving strategies and emerging therapies to improve outcome. World J Gastroenterol 2014; 20:12473-12484. [PMID: 25253947 PMCID: PMC4168080 DOI: 10.3748/wjg.v20.i35.12473] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 01/28/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing worldwide, largely due to hepatitis B virus (HBV), hepatitis C virus and liver cirrhosis. Chronic HBV infection is estimated to cause 55%-60% of the cases of HCC worldwide and over 70% in Asian countries. Liver resection is currently the mainstay of treatment due to the low surgical mortality, a wider treatment indication, and simplicity of post-treatment follow-up. There is an ever-increasing demand on surgeons to perform curative liver resection in HCC, with the hope of avoiding tumor recurrences. Hepatitis B-related-HCC has distinct clinicopathological features, which should be considered when treating the disease. The author presents a review of the recently evolving strategies and emerging therapies to improve HCC postresectional outcomes and focus on perioperative measures to improve patient outcome, with particular reference to the current status of adjuvant therapies in HCC patients after liver resection.
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MESH Headings
- Antiviral Agents/therapeutic use
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/secondary
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/virology
- Chemotherapy, Adjuvant
- Hepatectomy/adverse effects
- Hepatectomy/methods
- Hepatectomy/mortality
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/mortality
- Humans
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Neoplasms/virology
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Neoplasm, Residual
- Treatment Outcome
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Abstract
Hepatocellular Carcinoma (HCC) continues to present major challenges in management, which is further complicated by the presence of associated chronic liver disease. Key issues in surgical resection of HCC include the site, size, and number of lesions, the severity of the chronic liver disease, and the size of the functional liver remnant. De novo HCC in the absence of chronic liver disease can be treated by major liver resection with little risk of postoperative liver failure. Liver resection can also be used a bridge to liver transplantation as it affords the possibility of determining the pathologic grade of the tumortumor and its invasiveness, and thereby the prognosis. This review summarizes the current treatment approaches to surgical resection for HCC.
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Key Words
- AFP, alpha-fetoprotein
- AFP/TTV, AFP to tumor volume
- ASA, American Society of Anesthesiologists
- BCLC, barcelona clinic liver cancer
- CT, computerized tomography
- CTP, child-turcotte-pugh
- CUSA, cavitary ultrasound suction aspirator
- FDG-PET, fludeoxyglucose positron emission tomography
- FLR, functioning liver remnant
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HPB, hepato-pancreato-biliary
- HVPG, hepatic venous pressure gradient
- MELD, model for end-stage liver disease
- PEI, percutaneous ethanol injection
- POLT, primary orthotopic liver transplantation
- PVE, portal vein embolization
- RFA, radiofrequency ablation
- TACE, transarterial chemoembolization
- UCSF, University of California, San Francisco
- hepatocellular carcinoma
- liver cancer
- liver tumor
- resection
- surgery
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Affiliation(s)
- Hariharan Ramesh
- Address for correspondence: Hariharan Ramesh, Director of Surgical Gastroenterology & Liver Transplantation, Lakeshore Hospital & Research Center, Cochin, Kerala, India.
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43
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Lu WP, Dong JH. Hepatectomy for hepatocellular carcinoma in the era of liver transplantation. World J Gastroenterol 2014; 20:9237-9244. [PMID: 25071316 PMCID: PMC4110553 DOI: 10.3748/wjg.v20.i28.9237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/05/2014] [Accepted: 06/13/2014] [Indexed: 02/07/2023] Open
Abstract
The aim of management of hepatocellular carcinoma (HCC) is to improve the prognosis of the patients by radical resection and preserve remnant liver function. Although liver transplantation is associated with a lower tumor recurrence rate, this benefit is counteracted by long-term complications. Therefore, hepatectomy could be the first choice of treatment in selected patients with HCC. However, the higher frequency of tumor recurrence and the lower rate of resectability after hepatectomy for HCC led to an unsatisfactory prognosis. New strategies are required to improve the long-term outcome of HCC after hepatectomy. In this paper, we introduce some strategies to increase the low rate of resectability and reduce the high rate of tumor recurrence. Some aggressive treatments for tumor recurrence to extend long-term survival are also involved. We believe that hepatectomy combined with other therapies, such as portal vein embolization, transarterial chemoembolization, radioembolization, antiviral treatment, radiofrequency ablation and salvage transplantation, is a promising treatment modality for HCC and may improve survival greatly.
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44
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Vennarecci G, Laurenzi A, Levi Sandri GB, Busi Rizzi E, Cristofaro M, Montalbano M, Piselli P, Andreoli A, D'Offizi G, Ettorre GM. The ALPPS procedure for hepatocellular carcinoma. Eur J Surg Oncol 2014; 40:982-8. [PMID: 24767805 DOI: 10.1016/j.ejso.2014.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours. METHODS ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR. RESULTS The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months. CONCLUSIONS This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.
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Affiliation(s)
- G Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
| | - A Laurenzi
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - G B Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - E Busi Rizzi
- Division of Radiology, S. Camillo Hospital, Rome, Lazio, Italy
| | - M Cristofaro
- Division of Radiology, S. Camillo Hospital, Rome, Lazio, Italy
| | - M Montalbano
- Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - P Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - A Andreoli
- Hepatology, S. Camillo Hospital, Rome, Lazio, Italy
| | - G D'Offizi
- Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - G M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
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45
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Zhang Y, Shi ZL, Yang X, Yin ZF. Targeting of circulating hepatocellular carcinoma cells to prevent postoperative recurrence and metastasis. World J Gastroenterol 2014; 20:142-7. [PMID: 24415867 PMCID: PMC3886003 DOI: 10.3748/wjg.v20.i1.142] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/16/2013] [Accepted: 11/28/2013] [Indexed: 02/06/2023] Open
Abstract
Currently, the main treatment for hepatocellular carcinoma (HCC) involves the surgical removal of tumors or liver transplantation. However, these treatments are often not completely curative, as they are associated with a risk for postoperative recurrence and metastasis. Circulating tumor cells (CTCs) are increasingly recognized as the main source for recurrence and metastasis after radical hepatectomies are performed. Many studies have demonstrated the association between the presence of either pre- or postoperative CTCs and an increased risk for HCC recurrence. To improve the therapeutic outcome of HCC, a personalized, comprehensive and multidisciplinary approach should be considered, involving the application of appropriate diagnostic and therapeutic measures targeting HCC CTCs in different stages throughout the course of treatment. This article proposes some HCC CTC-based strategies for the treatment of HCC, including the monitoring of HCC CTCs before, during and after radical hepatectomy, therapeutic targeting of HCC CTCs, prevention of the generation and colonization of CTCs, as well as the use of CTC indexes for the selection of indications, prediction of prognoses, and planning of individualized therapeutic regimens. Innovation and technological development of therapies targeting CTCs, as well as their translation into clinical practice, will help to effectively reduce postoperative recurrence and metastasis, and significantly prolong the survival of HCC patients.
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MESH Headings
- Animals
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/metabolism
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/secondary
- Carcinoma, Hepatocellular/surgery
- Chemotherapy, Adjuvant
- Hepatectomy/adverse effects
- Hepatectomy/mortality
- Humans
- Liver Neoplasms/metabolism
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Molecular Targeted Therapy
- Neoplasm Recurrence, Local/prevention & control
- Neoplastic Cells, Circulating/drug effects
- Neoplastic Cells, Circulating/metabolism
- Neoplastic Cells, Circulating/pathology
- Treatment Outcome
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Azoulay D, Pascal G, Salloum C, Adam R, Castaing D, Tranecol N. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg 2014; 100:1764-75. [PMID: 24227362 DOI: 10.1002/bjs.9295] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The resectability criteria for malignant liver tumours have expanded during the past two decades. The use of vascular reconstruction after hepatectomy has been integral in this process. However, the majority of reports are anecdotal. This is a retrospective analysis of the techniques, morbidity, mortality and risk factors of liver resections with vascular reconstruction based on a large series from a single centre. METHODS Patients who underwent hepatic resection combined with vascular resection and reconstruction between 1997 and 2009 were included in this study. Indications for surgery, morbidity and 90-day mortality are reported along with factors predictive of operative mortality. RESULTS Eighty-four patients had liver resection with 97 vascular resections and reconstruction. There were 44 men and 40 women with a mean(s.d.) age of 56·9(12·1) years. Mean(s.d.) follow-up was 37·3(34·1) months. All patients had primary or metastatic liver tumours. The perioperative morbidity rate was 62 per cent (52 patients) and the operative mortality rate 14 per cent (12). Predictors of operative mortality were: bilirubin level exceeding 34 µmol/ml (P = 0·023), indocyanine green retention rate at 15 min over 10 per cent (P = 0·031), duration of ischaemia (P = 0·011), amount of blood transfused (P = 0·025) and combined major extrahepatic procedure (P = 0·042). Actuarial 3- and 5-year survival rates were 44 and 26 per cent respectively. CONCLUSION Liver resection with combined vascular resection and reconstruction can be performed in selected patients with acceptable morbidity and mortality. The lack of therapeutic alternatives and the poor outcome of non-operative management seem to justify this approach. The identification of risk factors should help improve patient selection and postoperative outcome as well as facilitate objective risk communication with surgical candidates.
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Affiliation(s)
- D Azoulay
- Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Paul Brousse, Villejuif; Service de Chirurgie Hépato-Bilio-Pancreatique, AP-HP Hôpital Henri Mondor, Créteil, France
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Coppa J, Citterio D, Cotsoglou C, Germini A, Piccioni F, Sposito C, Mazzaferro V. Transhepatic anterior approach to the inferior vena cava in large retroperitoneal tumors resected en bloc with the right liver lobe. Surgery 2013; 154:1061-8. [PMID: 24139491 DOI: 10.1016/j.surg.2013.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/16/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The operative approach to large retrohepatic tumors can be challenging because of the difficulty in exposing the inferior vena cava (IVC) and controlling bleeding. The anterior approach to the IVC associated with the hanging maneuver for liver transection, originally described in large hepatic tumors, may also facilitate removal of large masses set behind the liver. METHODS A prospective cohort of 10 patients with large retrohepatic tumors involving the IVC was selected according to restrictive criteria (ie, single low-grade tumor, sufficient liver remnant, normal hepatic function, absence of cholestasis, and symptoms secondary to lower vena cava obstruction). In all cases, the anterior approach and the hanging maneuver were applied intentionally to expose the IVC without any liver mobilization. Depending on tumor invasiveness, either IVC-preserving (n = 7) or IVC-removing (n = 3) strategies were applied. Our aim was to assess the safety of the technique and the possible benefits for patient outcome. RESULTS The cohort represented less than 1% of a series of 1,168 major hepatectomies performed in our unit between 2005 and 2011. The median age of the patients was 58; adrenal tumors and retroperitoneal sarcomas accounted for 70% of the series. Total vascular liver exclusion was necessary in 3 patients. Median operative time was 420 min. R0 resection was obtained in all cases, with no mortality and 40% overall morbidity. Overall survival was 83% at 5 years. CONCLUSION The transhepatic, anterior approach to the IVC is a safe procedure that improves vascular control, facilitates vein repair or reconstruction, and allows potentially curative resection of large retrohepatic tumors. This approach should be the preferred choice to be adopted in properly selected patients.
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Affiliation(s)
- Jorgelina Coppa
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, Milan, Italy
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48
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A safe combined nephrectomy and right lobectomy using the liver hanging maneuver for huge renal cell carcinoma directly invading the right lobe of the liver: report of a case. Surg Today 2013; 44:1778-82. [PMID: 24048764 PMCID: PMC4138431 DOI: 10.1007/s00595-013-0693-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 04/19/2013] [Indexed: 11/19/2022]
Abstract
We herein discuss a patient who underwent simultaneous combined right nephrectomy and right lobectomy of the liver. A 64-year-old male was diagnosed with a huge right renal cell carcinoma (RCC), 13 cm in diameter, which was invading directly into the right hepatic lobe. This type of RCC has been rarely reported, and an anterior approach using the liver hanging maneuver was extremely useful during hepatic parenchymal dissection. The liver parenchymal dissection was performed prior to mobilization of the liver, because the mobilization of the right lobe of the liver was impossible. During the hepatic parenchymal resection, the liver was suspended with the tape and transected, and thereafter, retroperitoneal dissection, nephrectomy and right lobectomy of the liver were completed. The patient was discharged from the hospital on the 12th postoperative day with an uneventful clinical course. The anterior approach using the liver hanging maneuver during hepatic parenchymal resection can be safe and feasible for huge RCC invading the right hepatic lobe.
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49
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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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50
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Lee SY, Cherqui D, Kluger MD. Extended right hepatectomy in a liver with a non-bifurcating portal vein: the hanging maneuver protects the portal system in the presence of anomalies. J Gastrointest Surg 2013; 17:1494-9. [PMID: 23404171 DOI: 10.1007/s11605-013-2161-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/29/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Variations in portal vein anatomy occur in 20-35 % of individuals. A non-bifurcating portal vein (PV) was suspected on preoperative imaging in a patient with a large right lobe hepatocellular carcinoma. The single PV curved within the liver parenchyma from right to left supplying second-order branches along its course. CASE REPORT Utilizing the hanging maneuver, an extended right hemihepatectomy was safely performed. This approach allowed for preservation of the main PV and its left-sided branches while easily identifying the second-order right branches for ligation. CONCLUSION Knowledge of portal vein variations and identification preoperatively by cross-sectional imaging are critical. The hanging maneuver aids in the preservation of the main portal vein and its left-sided branches during right hemihepatectomy in the presence of portal vein anomalies, and this technique can be used to improve safety in hepatobiliary surgery.
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Affiliation(s)
- Ser Yee Lee
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA
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