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Liver Transection with Precoagulation Therapy in Liver Cirrhosis: Effective Use of an Energy Device at Hepatectomy. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Hepatectomy for liver cirrhosis patients requires skillful surgical technique and careful attention because of the fibrotic parenchyma, elevated portal pressure, and impaired coagulation. This report evaluated short- and long-term outcomes for liver cirrhosis patients receiving precoagulation therapy on the parenchymal transection plane, compared with noncoagulation cases.
Methods
Seventy-three patients diagnosed with cirrhosis via postoperative pathological findings were selected after reviewing 887 hepatectomy patient files. They were divided into a precoagulation group (n = 20) and a noncoagulation group (n = 53). There were no significant differences in patient and tumor factors between 2 groups.
Results
The precoagulation group had significantly less blood loss compared with noncoagulation group [282 vs 563g (P < 0.05)], shorter operative time [214 vs 276 min (P = 0.06)], and shorter postoperative hospital stays [14.5 vs 22.5 days (P = 0.12)]. The median recurrence free survival rates time in the pre-coagulation group (733 days) was significantly longer than that in the non-coagulation group (400 days) (P < 0.05). Overall survival rates showed rates showed no difference between the 2 groups (P = 0.62).
Conclusions
Precoagulation therapy may be the a preferred treatment application for hepatectomy patients with severe liver fibrosis.
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Wakabayashi T, Benedetti Cacciaguerra A, Ciria R, Ariizumi S, Durán M, Golse N, Ogiso S, Abe Y, Aoki T, Hatano E, Itano O, Sakamoto Y, Yoshizumi T, Yamamoto M, Wakabayashi G. Landmarks to identify segmental borders of the liver: A review prepared for PAM-HBP expert consensus meeting 2021. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:82-98. [PMID: 33484112 DOI: 10.1002/jhbp.899] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In preparation for the upcoming consensus meeting in Tokyo in 2021, this systematic review aimed to analyze the current available evidence regarding surgical anatomy of the liver, focusing on useful landmarks, strategies and technical tools to perform precise anatomic liver resection (ALR). METHODS A systematic review was conducted on MEDLINE/PubMed for English articles and on Ichushi database for Japanese articles until September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS A total of 3169 manuscripts were obtained, 1993 in English and 1176 in Japanese literature. Subsequently, 63 English and 20 Japanese articles were selected and reviewed. The quality assessment of comparative series and case series was revealed to be usually low; only six articles were qualified as high quality. Forty-two articles focused on analyzing intersegmental/sectional planes and their relationship with specific hepatic landmark veins. In 12 articles, the authors aimed to investigate liver surface anatomic structures, while 36 articles aimed to study technological tools and contrast agents for surgical segmentation during ALR. Although Couinaud's classification has remained the cornerstone in daily diagnostic/surgical practices, it does not always portray the realistic liver segmentation and there has been no standardization on which a single strategy should be followed to perform precise ALR. CONCLUSIONS A global consensus should be pursued in order to establish clear guidelines and proper recommendations to perform ALR in the era of minimally invasive surgery.
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Affiliation(s)
- Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Andrea Benedetti Cacciaguerra
- Department of Surgery, Hepato-Pancreato-Biliary, Minimally Invasive and Robotic Unit, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, Spain
| | - Shunichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Manuel Durán
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, Spain
| | - Nicolas Golse
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Satoshi Ogiso
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Etsuro Hatano
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Yoshihiro Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
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3
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Felli E, Cherkaoui Z, Pessaux P. Clinical efficacy of liver resection combined with adjuvant microwave coagulation for patients with hepatocellular carcinoma: a promising approach to minimize recurrence? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1123. [PMID: 33240972 PMCID: PMC7576037 DOI: 10.21037/atm-2020-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emanuele Felli
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France.,Institut of Viral and Liver Disease, Inserm U1110, Strasbourg, France
| | - Zineb Cherkaoui
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France
| | - Patrick Pessaux
- Digestive and Endocrine Surgery, HPB Unit, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.,IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France.,Institut of Viral and Liver Disease, Inserm U1110, Strasbourg, France
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Zhang T, Wang M, Zhang X, Hu J, Dou W, Fan Q, Feng D, Liu L. Analysis of the clinical efficacy of liver resection combined with adjuvant microwave coagulation for patients with hepatocellular carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:585. [PMID: 32566612 PMCID: PMC7290546 DOI: 10.21037/atm.2020.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Liver resection has been widely applied as a curative measure in the treatment of hepatocellular carcinoma (HCC) patients. However, the high rate of postoperative recurrence observed following liver resection proposes a problem, the solution for which is yet to be well established. Microwave coagulation is a therapy that was recently proposed as an adjuvant tool. In this study, we intended to evaluate the effectiveness of microwave coagulation as an auxiliary therapeutic method for patients undergoing liver resection. Methods A total of 236 consecutive patients classified as Barcelona Clinic Liver Cancer (BCLC) stage A who had only one tumor were enrolled in this retrospective study, regardless of tumor size. Survival analyses were performed using the Kaplan-Meier method, and the statistical differences between patients who underwent liver resection with and without adjuvant microwave coagulation were examined by the log-rank test. To investigate the prognostic factors for OS, we carried out univariate and multivariate Cox regression analyses. Results Based on the Kaplan-Meier curves, patients who underwent surgical resection with intraoperative adjuvant microwave coagulator had prolonged recurrence-free survival time and showed better overall survival (OS) than those who underwent surgical resection alone, with OS at 1, 3, and 5 years of 77.8%, 33.2%, 12.6% vs. 58.2%, 15.5%, 9.7%, respectively (log-rank P<0.001). The univariate and multivariate analyses demonstrated that tumor size, albumin, bilirubin, Child-Pugh score, and treatment method had significant prognostic power for both PFS and OS. According to the subgroup analyses based on the tumor size, there were significant differences in PFS and OS among overall subsets between the liver resection with adjuvant microwave coagulator and liver resection only groups. Conclusions Liver resection combined with intraoperative adjuvant microwave coagulation had a better prognostic performance than treatment with liver resection alone. Adjuvant microwave coagulation should be suggested as an alternative treatment modality for BCLC stage A patients with a single tumor, regardless of its size.
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Affiliation(s)
- Ting Zhang
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Mengmeng Wang
- Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China
| | - Xiangnan Zhang
- Division of Scientific Research, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Jie Hu
- Department of Clinical laboratory, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Weijia Dou
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Qingling Fan
- Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China
| | - Dayun Feng
- Department of Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lei Liu
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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Yang G, Xiong Y, Sun J, Wang G, Li W, Tang T, Li J. The efficacy of microwave ablation versus liver resection in the treatment of hepatocellular carcinoma and liver metastases: A systematic review and meta-analysis. Int J Surg 2020; 77:85-93. [PMID: 32173611 DOI: 10.1016/j.ijsu.2020.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/22/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Microwave ablation (MWA) is an important method in the treatment of liver cancer. This systematic review compared MWA with liver resection (LR) for liver cancer treatment. In recent years, the MWA has been also reported to play an important role. Studies comparing MWA and LR are lacking. This study aims to compare the efficacy of MWA and LR in the treatment of hepatocellular carcinoma (HCC). METHODS A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to April 1, 2019 was conducted for relevant studies that compared the efficacy of MWA and LR in the treatment of HCC. The primary outcomes were local tumor recurrence (LTR) and overall survival (OS) of patients. The secondary outcomes included disease free survival (DFS), extrahepatic metastasis, intrahepatic de novo lesions, length of stay, complications, intraoperative blood loss and operative time. RESULTS A total of 16 studies including 2622 patients were identified. Incidence of LTR was significantly higher in patients with MWA than LR, with a pooled OR of 2.69 (95% CI 1.33-5.41; P = 0.006). No significant difference in 1-year OS was found. However, patients with MWA experienced higher 3- and 5-year OS, with pooled ORs of 1.40 (95% CI 1.07-1.84; P = 0.01) and 1.41 (95% CI 1.10-1.80; P = 0.007) respectively. In secondary measures, the 1- and 3-year DFS were significantly higher in patients with MWA. However, no significant difference of 5-year DFS was observed. In addition, lower incidence of complications, less intraoperative blood loss and shorter operative time and shorter length of stay were observed in MWA. CONCLUSIONS Though MWA may lead to higher incidence of recurrence, it may be an effective and safe alternative in patients with HCC or liver metastases. MWA may have benefits in patients' survival and safety. Randomized studies should be performed to determine the target population that benefits most from MWA in the future.
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Affiliation(s)
- Gang Yang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Yongfu Xiong
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China; Institute of Hepato-biliary-intestinal Disease, North Sichuan Medical College, Nanchong, 637000, China
| | - Ji Sun
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Guan Wang
- Physical Examination Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Weinan Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Tao Tang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Jingdong Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China; Institute of Hepato-biliary-intestinal Disease, North Sichuan Medical College, Nanchong, 637000, China.
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Wu T, Zhou B, Sun Z, Feng L, Pan J, Yu J, Zhang S, Yan S. Laparoscopic hepatectomy assisted by a flexible 915 MHz microwave antenna: A safe and innovative device for hepatectomy. Surg Oncol 2019; 31:1-6. [PMID: 31442875 DOI: 10.1016/j.suronc.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 02/22/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of the present study was to elaborate a flexible 915 MHz microwave antenna (F915 MMA) and to evaluate the safety and feasibility in laparoscopic hepatecyomy (LH). METHODS The F915 MMA was redesigned based on the experiences in clinical practice. Ten porcine LHs were divided into a 'flexible' group and a control group, with 5 porcine LHs in each group. The F915 MMA was used in the flexible group. The data for 48 patients who underwent LH were analyzed; 12 patients underwent F915 MMA-assisted LH and were regarded as the flexible group, and the others were considered as controls. RESULTS The F915 MMA bends freely and rotates flexibly. In the porcine LH in vivo, the flexible group had less intraoperative blood loss (54.00 ± 27.02 ml vs 230.00 ± 83.67 ml, P = 0.002), and the mean duration of hepatic parenchyma transection in the flexible group was significantly shorter than that in the control group (17.3 ± 7.8min vs 37.9 ± 6.4min). Among th patients, compared to the control group, the flexible group had less intraoperative blood loss (154.17 ± 68.95 ml vs 284.86 ± 294.68 ml, P = 0.018), less frequency and duration of the first porta hepatic occlusion (1.50 ± 0.52times vs 2.35 ± 1.14times, P = 0.021 and 22.50 ± 7.83min vs 35.95 ± 17.23min, P = 0.017, respectively) and lower accumulative complications (33.3% vs 80.5%, P = 0.008). CONCLUSIONS Laparoscopic F915 MMA is an innovative device that can assist LH in a safe, feasible and flexible manner.
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Affiliation(s)
- Tianchun Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhongquan Sun
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Liushun Feng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jie Pan
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jinbei Yu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shuijun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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7
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Glassberg MB, Ghosh S, Clymer JW, Wright GWJ, Ferko N, Amaral JF. Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. World J Surg Oncol 2019; 17:98. [PMID: 31182102 PMCID: PMC6558848 DOI: 10.1186/s12957-019-1632-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Hepatic resection (HR) is the gold standard liver cancer treatment, but few patients are eligible due to comorbidities or tumor location. Microwave ablation (MWA) is an important complementary liver cancer treatment to HR. This systematic review compared MWA with HR for liver cancer treatment. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted for randomized and observational studies published from 2006 onwards. The primary outcome was local tumor recurrence (LTR), and a random effects model was used for meta-analyses. Results Of the 1845 studies identified, 1 randomized and 15 observational studies met the inclusion criteria. LTR was significantly increased with MWA versus HR (risk ratio (RR) = 2.49; P = 0.016). In secondary measures, HR provided significantly higher 3- and 5-year overall survival (RR = 0.94; P = 0.03 and RR = 0.88; P = 0.01, respectively) and 3-year disease-free survival (RR = 0.78; P = 0.009). MWA exhibited significantly shorter length of stay (weighted mean difference (WMD) = − 6.16 days; P < 0.001) and operative time (WMD = − 58.69 min; P < 0.001), less intraoperative blood loss (WMD = − 189.09 mL; P = 0.006), and fewer complications than HR (RR = 0.31; P < 0.001). When MWA was combined with HR and compared with either modality alone, complications and blood loss were significantly lower with the combination treatment; however, there were no differences in other outcomes. Subgroup and sensitivity analyses were generally aligned with the main results. Conclusions MWA can be an effective and safe alternative to HR in patients/tumors that are not amenable to resection. More randomized and economic studies should be performed that compare the two treatments, especially to determine the target population that benefits most from MWA. Electronic supplementary material The online version of this article (10.1186/s12957-019-1632-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sudip Ghosh
- Ethicon Inc., 4545 Creek Rd, Cincinnati, OH, 45242, USA
| | | | - George W J Wright
- Cornerstone Research Group Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada.
| | - Nicole Ferko
- Cornerstone Research Group Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada
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Rao Z, Ling W, Dai X, Zhang H, Pu L, Wu J, Zhu D, Yang X, Li Z, Lu L, Wang X, Zhou H, Kong L. Precoagulation with microwave ablation for hepatic parenchymal transection during liver partial resection. Int J Hyperthermia 2018; 36:146-150. [PMID: 30484720 DOI: 10.1080/02656736.2018.1540799] [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] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility of precoagulation with microwave ablation (MWA) for hepatic parenchymal transection during liver partial resection. METHODS A total of 66 eligible patients were enrolled in this double-blind, randomized, controlled study. Patients were randomized to receive either the traditional clamp-crushing method (Control group) or the MWA precoagulation method (MWA group) for hepatic parenchymal transection during liver partial resection. The operative time, hepatic portal occlusion time, intraoperative blood loss and transfusion, postoperative complications and recovery outcomes were compared. RESULTS Compared to the Control group, the MWA group had significantly less intraoperative blood loss. Fewer red blood cell transfusions were observed in the MWA group but without statistical significance. The MWA group showed significantly higher serum alanine aminotransferase and aspartate aminotransferase levels at day 1 postoperatively, but no differences between the MWA and Control groups were found at days 3 and 7. There were no significant differences in terms of operative time, hepatic portal occlusion time, postoperative total bilirubin levels, human albumin solution consumption or length of hospital stay. Postoperative complications such as impaired renal function, pyrexia, admission to ICU, abscess, biliary leakage, intrahepatic and distant tumor recurrence and in-hospital mortality were comparable between the two groups. CONCLUSION Precoagulation with MWA reduced intraoperative blood loss with similar postoperative complications, providing a safe, effective, novel alternative for hepatic parenchymal transection during liver partial resection. Additional results from larger series are recommended to confirm these findings.
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Affiliation(s)
- Zhuqing Rao
- a Department of Anaesthesiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Wei Ling
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Xinzheng Dai
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Hui Zhang
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Liyong Pu
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Jindao Wu
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Deming Zhu
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Xiao Yang
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Zhi Li
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Ling Lu
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Xuehao Wang
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Haoming Zhou
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China
| | - Lianbao Kong
- b Hepatobiliary/Liver Transplantation Center , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.,c Key Laboratory of Liver Transplantation , Chinese Academy of Medical Sciences , Nanjing , China.,d Department of General Surgery , Sir Run Run Hospital, Nanjing Medical University , Nanjing , China
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9
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Sun Y, Zhang G, Yu J, Dong L, Liu W, Liang P. Evaluation of percutaneous microwave coagulation therapy for hepatic artery injury. Heliyon 2016; 1:e00030. [PMID: 27441219 PMCID: PMC4939808 DOI: 10.1016/j.heliyon.2015.e00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022] Open
Abstract
Objectives To evaluate the in vivo efficacy of 915 MHz percutaneous coagulation in the treatment of hepatic artery injury. Methods After inducing hepatic artery injury, 8 dogs in each group underwent 915 MHz microwave percutaneous coagulation therapy and 8 dogs were injected with batroxobin and α-cyanoacrylate. Results The hemostatic effects of 915 MHz microwave were better than drug injection, and the amount of bleeding was significantly lower (p < 0.05). Pathological examination showed that vessel wall necrosis were greater. Conclusion Contrast ultrasound guided 915 MHz microwave percutaneous coagulation treatment has potent hemostatic effects in the repair of in vivo hepatic artery injury.
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Affiliation(s)
- Yuanyuan Sun
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Guoming Zhang
- Department of Cardiology, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Dong
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China
| | - Wei Liu
- The Nanjing Kangyou Institute of Microwave Energy, Nanjing 210000, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
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10
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Sasaki K, Matsuda M, Hashimoto M, Watanabe G. Liver resection for hepatocellular carcinoma using a microwave tissue coagulator: Experience of 1118 cases. World J Gastroenterol 2015; 21:10400-10408. [PMID: 26420966 PMCID: PMC4579886 DOI: 10.3748/wjg.v21.i36.10400] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/08/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To present our extensive experience of hepatectomy for hepatocellular carcinoma using a microwave tissue coagulator to demonstrate the effectiveness of this device.
METHODS: A total of 1118 cases (1990-2013) were reviewed, with an emphasis on intraoperative blood loss, postoperative bile leakage and fluid/abscess formation, and adaptability to anatomical resection and hepatectomy with hilar dissection.
RESULTS: The median intraoperative blood loss was 250 mL; postoperative bile leakage and fluid/abscess formation were seen in 3.0% and 3.3% of cases, respectively. Anatomical resection was performed in 275 cases, including 103 cases of hilar dissection that required application of microwave coagulation near the hepatic hilum. There was no clinically relevant biliary tract stricture or any vascular problems due to heat injury. Regarding the influence of cirrhosis on intraoperative blood loss, no significant difference was seen between cirrhotic and non-cirrhotic patients (P = 0.38), although cirrhotic patients tended to have smaller tumors and underwent less invasive operations.
CONCLUSION: This study demonstrated outcomes of an extensive experience of hepatectomy using heat coagulative necrosis by microwave tissue coagulator.
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Reich DJ. Liver resection after thermal ablation of parenchymal transection margin using microwave energy. Clin Liver Dis (Hoboken) 2015; 5:25-28. [PMID: 31040942 PMCID: PMC6490457 DOI: 10.1002/cld.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- David J. Reich
- Division of Multiorgan Transplantation and Hepatobiliary Surgery and Department of SurgeryDrexel University College of MedicineHahnemann University HospitalPhiladelphiaPA
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12
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Beppu T, Nitta H, Tsukamoto M, Imai K, Hayashi H, Okabe H, Hashimoto D, Chikamoto A, Ishiko T, Baba H. Percutaneous radiofrequency ablation-assisted laparoscopic hepatectomy. Asian J Endosc Surg 2014; 7:188-92. [PMID: 24754887 DOI: 10.1111/ases.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/09/2013] [Accepted: 12/15/2013] [Indexed: 12/07/2022]
Abstract
Metachronous rectal liver metastasis (15 mm in segment 8 ventral) was managed with laparoscopic hepatectomy using segmental blood flow occlusion with radiofrequency ablation. During liver dissection, the ischemic area was visible as a distinct hypoechoic area on intraoperative enhanced ultrasound; with a photodynamic eye camera, it appeared as a discolored lesion. The resection was completed with adequate margins.
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Affiliation(s)
- Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Multidisciplinary Treatment for Gastroenterological Cancer, Innovation Center for Translational Research, Kumamoto University Hospital, Kumamoto, Japan
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Tan K, DU X, Yin J, Dong R, Zang L, Yang T, Chen Y. Microwave tissue coagulation technique in anatomical liver resection. Biomed Rep 2014; 2:177-182. [PMID: 24649092 DOI: 10.3892/br.2014.227] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/16/2013] [Indexed: 02/06/2023] Open
Abstract
Anatomical liver resection is currently the preferred treatment for liver cancer. With the recent introduction of medical microwave coagulation for liver metastases, anatomical hepatectomy may be performed more efficiently. The present study retrospectively reviewed the results of microwave tissue coagulation performed during anatomical liver resection for patients with liver disease at the TangDu Hospital (Xi'an, China) between January, 2009 and June, 2012. A total of 128 patients met the inclusion criteria and were divided into two groups for comparison; those treated with the microwave coagulation technique (n=66) and the conventional group (n=62), who were treated with standard partial hepatectomy. There was no reported perioperative mortality. The univariate analysis revealed that the duration of liver dissection, intraoperative blood loss, intraoperative erythrocyte transfusion volume and alanine aminotransferase levels on the 5th postoperative day were significantly different between the microwave and conventional groups (P<0.05). Therefore, microwave tissue coagulation in anatomical liver resection was shown to be efficacious and safe and, provided proficient skills are developed in this technique, microwave tissue coagulation may be an effective alternative to anatomical hepatectomy.
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Affiliation(s)
- Kai Tan
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xilin DU
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jikai Yin
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Rui Dong
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Li Zang
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Tao Yang
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Yafeng Chen
- Department of General Surgery, Second Division, TangDu Hospital Affiliated to the Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
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Cao XL, Li H, Yu XL, Liang P, Dong BW, Fan J, Li M, Liu FY. Predicting early intrahepatic recurrence of hepatocellular carcinoma after microwave ablation using SELDI-TOF proteomic signature. PLoS One 2013; 8:e82448. [PMID: 24349287 PMCID: PMC3862627 DOI: 10.1371/journal.pone.0082448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/03/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS Despite great progress in the treatment of hepatocellular carcinoma (HCC) over the last-decade, intrahepatic recurrence is still the most frequent serious adverse event after all the treatments including microwave ablation. This study aimed to predict early recurrence of HCC after microwave ablation using serum proteomic signature. METHODS After curative microwave ablation of HCC, 86 patients were followed-up for 1 year. Serum samples were collected before microwave ablation. The mass spectra of proteins were generated using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS). Serum samples from 50 patients were randomly selected as a training set and for biomarkers discovery and model development. The remaining serum samples were categorized for validation of the algorithm. RESULTS According to preablation serum protein profiling obtained from the 50 HCC samples in the training set, nine significant differentially-expressed proteins were detected in the serum samples between recurrent and non-recurrent patients. Decision classification tree combined with three candidate proteins with m/z values of 7787, 6858 and 6646 was produced using Biomarker Patterns Software with sensitivity of 85.7% and specificity of 88.9% in the training set. When the SELDI marker pattern was tested with the blinded testing set, it yielded a sensitivity of 80.0%, a specificity of 88.5% and a positive predictive value of 86.1%. CONCLUSIONS Differentially-expressed protein peaks in preablation serum screened by SELDI are associated with prognosis of HCC. The decision classification tree is a potential tool in predicting early intrahepatic recurrence in HCC patients after microwave ablation.
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Affiliation(s)
- Xiao-lin Cao
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
- Department of Ultrasound, Southern Building Clinic Division, General Hospital of People's Liberation Army, Beijing, China
| | - Hua Li
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
- Department of Ultrasound, the 306 Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xiao-ling Yu
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
- * E-mail: (XlY); (PL)
| | - Ping Liang
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
- * E-mail: (XlY); (PL)
| | - Bao-wei Dong
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
| | - Jin Fan
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
| | - Meng Li
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
| | - Fang-yi Liu
- Department of Interventional Ultrasound, General Hospital of People's Liberation Army, Beijing, China
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Jin S, Fu Q, Wuyun G, Wuyun T. Management of post-hepatectomy complications. World J Gastroenterol 2013; 19:7983-7991. [PMID: 24307791 PMCID: PMC3848145 DOI: 10.3748/wjg.v19.i44.7983] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatic resection had an impressive growth over time. It has been widely performed for the treatment of various liver diseases, such as malignant tumors, benign tumors, calculi in the intrahepatic ducts, hydatid disease, and abscesses. Management of hepatic resection is challenging. Despite technical advances and high experience of liver resection of specialized centers, it is still burdened by relatively high rates of postoperative morbidity and mortality. Especially, complex resections are being increasingly performed in high risk and older patient population. Operation on the liver is especially challenging because of its unique anatomic architecture and because of its vital functions. Common post-hepatectomy complications include venous catheter-related infection, pleural effusion, incisional infection, pulmonary atelectasis or infection, ascites, subphrenic infection, urinary tract infection, intraperitoneal hemorrhage, gastrointestinal tract bleeding, biliary tract hemorrhage, coagulation disorders, bile leakage, and liver failure. These problems are closely related to surgical manipulations, anesthesia, preoperative evaluation and preparation, and postoperative observation and management. The safety profile of hepatectomy probably can be improved if the surgeons and medical staff involved have comprehensive knowledge of the expected complications and expertise in their management. This review article focuses on the major postoperative issues after hepatic resection and presents the current management.
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