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Berardi G, Colasanti M, Meniconi RL, Ferretti S, Guglielmo N, Mariano G, Burocchi M, Campanelli A, Scotti A, Pecoraro A, Angrisani M, Ferrari P, Minervini A, Gasparoli C, Wakabayashi G, Ettorre GM. The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery. Diagnostics (Basel) 2021; 11:2169. [PMID: 34943406 PMCID: PMC8700092 DOI: 10.3390/diagnostics11122169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers.
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Affiliation(s)
- Giammauro Berardi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Marco Colasanti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Roberto Luca Meniconi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Stefano Ferretti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Nicola Guglielmo
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Germano Mariano
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Mirco Burocchi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Alessandra Campanelli
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Andrea Scotti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Alessandra Pecoraro
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Marco Angrisani
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Paolo Ferrari
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Andrea Minervini
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Camilla Gasparoli
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Go Wakabayashi
- Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan;
| | - Giuseppe Maria Ettorre
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
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Clinical and oncological benefits of left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma. Surg Today 2021; 52:844-852. [PMID: 34724106 DOI: 10.1007/s00595-021-02401-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This retrospective study aimed to clarify whether the postoperative prognosis differs between right and left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma. METHODS Preoperative images of 195 patients with perihilar cholangiocarcinoma were reexamined. Patients with Bismuth type I/II perihilar cholangiocarcinoma without a difference in extraductal tumor invasion between the right and left sides of the hepatic portal region were classified into those undergoing left (L group) or right (R group) hepatectomy. RESULTS Twenty-three patients (11.8%) were classified into the L group and 33 (16.9%) into the R group. All eight patients with pTis/1 belonged to the L group. The L group had significantly less liver failure than the R group (p = 0.001). One patient (4.3%) in the L group and four patients (12.1%) in the R group died from postoperative complications. Among 48 patients with pT2, the L group tended to have better overall survival (median, 12.2 vs. 5.6 years; p = 0.072), but not recurrence-free survival (median, 9.1 vs. 3.6 years; p = 0.477), in comparison to the R group. CONCLUSIONS Postoperative survival after left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma is expected to be as long as that after right hepatectomy.
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Bednarsch J, Czigany Z, Heij LR, Luedde T, Loosen SH, Dulk MD, Bruners P, Lang SA, Ulmer TF, Neumann UP. The prognostic role of in-hospital transfusion of fresh frozen plasma in patients with cholangiocarcinoma undergoing curative-intent liver surgery. Eur J Surg Oncol 2021; 48:604-614. [PMID: 34565633 DOI: 10.1016/j.ejso.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Major hepatectomy for perihilar and intrahepatic cholangiocarcinoma (CCA) is often associated with a significant intraoperative blood loss and the requirement for perioperative transfusion of blood products. The aim of this study was to investigate the oncological impact of fresh frozen plasma (FFP) transfusion during hospitalization in patients undergoing hepatectomy for CCA as adverse effects have been described in other malignancies. MATERIAL AND METHODS Patients undergoing hepatectomy for CCA from 2010 to 2019 at a single institution were eligible for this study. Survival analysis was carried out according to Kaplan-Meier and the associations of cancer-specific (CSS) and recurrence-free survival (RFS) with in-hospital application of FFP and other clinico-pathological characteristics were assessed using Cox regression models. Perioperatively deceased patients were excluded from the analysis. RESULTS A total of 219 CCA patients were included in this survival analysis of which 53.0% (116/219) received FFP during hospitalization. Patients receiving in-hospital FFP showed a median CCS of 33 months (3-year-CSS = 46%, 5-year-CSS = 29%) compared to 83 months (3-year-CSS = 55%, 5-year-CSS = 53%) in patients who did not receive in-hospital FFP (p = 0.006 log rank). Further, in-hospital FFP was identified as an independent predictor of oncological outcome in multivariable analysis (CSS: HR = 1.71, p = 0.016; RFS: HR = 1.89, p = 0.003). CONCLUSION In a large European cohort of patients, in-hospital transfusion of FFP was identified as a novel independent prognostic marker in CCA patients undergoing curative-intent liver surgery. A restrictive transfusion policy is therefore recommended to improve long-term outcome in these patients.
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Affiliation(s)
- Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Lara R Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marcel den Dulk
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven A Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom F Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.
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