1
|
Safety and Perioperative Outcomes of Laparoscopic vs. Open Hepatectomy of Central-Located Liver Lesions: A Multicenter, Propensity Score-Matched, Retrospective Cohort Study. J Clin Med 2023; 12:jcm12062164. [PMID: 36983169 PMCID: PMC10057074 DOI: 10.3390/jcm12062164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Short-term outcomes of laparoscopic hepatectomy of central-located liver lesions (LHCL) compared with traditional open hepatectomy of central-located liver lesions (OHCL) remain unclear. The aim of this study was to explore the safety and efficacy of LHCL. Methods: A retrospective analysis was performed on 262 patients who underwent hepatectomies involving resections of liver segment II, IV or VIII from January 2015 to June 2021 in two institutions. Patients in the LHCL group were matched in a 1:2 ratio to patients in the OHCL group. Results: After propensity score-matched (PSM) analysis, 61 patients remained in the LHCL group and 122 patients were in the OHCL group. What needs to be mentioned is that although not significant, patients in the OHCL group had increased lesion size (4.3 vs. 3.6 cm, p = 0.052), number (single/multiple, 84.8%/15.2% vs. 93.4%/6.6%, p = 0.097), and number of liver segments involved (one/two/three, 47.3%/42.0%/10.7% vs. 57.4%36.1%/10.7%, p = 0.393). To ensure surgical safety, fewer patients in the LHCL group underwent vascular exclusion than those in the OHCL group (p = 0.004). In addition, LHCL was associated with lower blood loss (p = 0.001) and transfusion requirement (p = 0.004). In terms of short-term outcomes, the LHCL group had significantly lower levels of peak ALT (p < 0.001), peak DBIL (p = 0.042), peak PT (p = 0.012), and higher levels of bottom ALB (p = 0.049). Moreover, the LHCL group demonstrated quicker postoperative recovery, which was represented by shorter time to first flatus, time to oral intake, time to drain off, and hospital stay (all p < 0.001). Importantly, the LHCL group had a significantly reduced occurrence of postoperative complications (p < 0.001) and similar R0 resection rates (p = 0.678) when compared to the OHCL group. Conclusion: LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. From the experience of our center, LHCL could be performed to solitary lesion involving liver segment IV/V/VIII, <5 cm, with good safety and feasibility.
Collapse
|
2
|
Gadallah EA, Elkomos BE, Khalil A, Fawzy FS, Abdelaal A. Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: a systematic review and meta-analysis. BMC Surg 2023; 23:2. [PMID: 36600282 DOI: 10.1186/s12893-022-01891-7] [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: 08/12/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIM For those with a centrally located HCC, the two types of liver sectionectomy that can be performed are extended hepatectomy (EH) and central hepatectomy (CH). This meta-analysis aimed to compare the short- and long-term outcomes between patients treated with CH and patients treated with EH for those with centrally located HCC. METHOD We searched PubMed, Scopus, Web of Science, and Cochrane library for eligible studies from inception to 1 April 2022 and a systematic review and meta-analysis were done to compare the outcomes between the two groups. RESULTS we included 9 studies with a total of 1674 patients in this study. The pooled results in this meta-analysis showed equal long-term overall survival, Disease-free survival, recurrence and mortality between the two groups (5-year OS, RR = 1.14, 95% CI = 0.96-1.35, P = 0.12; I2 = 56%), (5-year DFS, RR = 0.81, 95% CI = 0.61-1.08, P = 0.15; I2 = 60%), (Recurrence, RR = 1.04, 95% CI = 0.94-1.15, P = 0.45; I2 = 27%), and (Mortality, RR = 0.55, 95% CI = 0.26-1.15, P = 0.11; I2 = 0%). In addition to that, no significant difference could be detected in the overall incidence of complications between the two groups (Complications, RR = 0.94, 95% CI = 0.76-1.16, P = 0.57; I2 = 0%). However, CH is associated with a remarkable increase in the rate of biliary fistula (Biliary fistula, RR = 1.90, 95% CI = 1.07-3.40, P = 0.03; I2 = 0%). And Liver cell failure was higher in the case of EH (LCF, RR = 0.47, 95% CI = 0.30-0.76, P = 0.002; I2 = 0%). Regarding the operative details, CH is associated with longer operative time (Time of the operation, Mean difference = 0.82, 95% CI = 0.36, 1.27, P = 0.0004; I2 = 57%). CONCLUSION No significant difference in the short and long-term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decreases the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumour recurrence.
Collapse
Affiliation(s)
| | | | - Ahmed Khalil
- General Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| | - Fawzy Salah Fawzy
- General Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| | - Amr Abdelaal
- General Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| |
Collapse
|
3
|
Zheng Z, Xie H, Liu Z, Wu X, Peng J, Chen X, He J, Zhou J. Laparoscopic central hepatectomy using a parenchymal-first approach: how we do it. Surg Endosc 2022; 36:8630-8638. [PMID: 36107243 DOI: 10.1007/s00464-022-09163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic central hepatectomy (LCH) is a difficult and challenging procedure. This study aimed to describe our experience with LCH using a parenchymal-first approach. METHODS Between July 2017 and June 2021, 19 consecutive patients underwent LCH using a parenchymal-first approach at our institution. Herein, the details of this procedural strategy are described, and the demographic and clinical data of the included patients were retrospectively analyzed. RESULTS There were 1 female and 18 male patients, all with hepatocellular carcinoma without major vascular invasion. The mean age was 57 ± 10 years. No patients underwent conversion to open surgery, and no blood transfusions were needed intraoperatively. The average operative duration and the average Pringle maneuver duration were 223 ± 65 min and 58 ± 11 min. respectively. The median blood loss was 200 ml (range: 100-800 ml). Postoperative morbidities occurred in 3 patients (15.8%), including 2 cases of bile leakage and 1 case of acquired pulmonary infection; there were no postoperative complications happened such as bleeding, hepatic failure, or mortality. The average postoperative hospital stay was 10 ± 3 days. CONCLUSION The optimized procedure of LCH using a parenchymal-first approach is not only feasible but also expected to provide an advantage in laparoscopic anatomical hepatectomy.
Collapse
Affiliation(s)
- Zhipeng Zheng
- Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Haorong Xie
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Zhangyuanzhu Liu
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Xiang Wu
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Jianxin Peng
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Xuefang Chen
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China
| | - Junming He
- Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China.
| | - Jie Zhou
- Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| |
Collapse
|
4
|
Liao K, Yu F, Cao L, Wang B, Li X, Wang X, Li J, Fan Y, Chen J, Zheng S. Laparoscopic Glissonian pedicle versus hilar dissection approach hemihepatectomy: A prospective, randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:629-640. [PMID: 35224875 DOI: 10.1002/jhbp.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ke‐Xi Liao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Fan Yu
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
- The Third Hospital of Mianyang Sichuan Mental Health Center Mianyang 621000 Sichuan China
| | - Li Cao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Bao‐Lin Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xue‐Song Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xiao‐Jun Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian‐Wei Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Yu‐Dong Fan
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian Chen
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Shu‐Guo Zheng
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| |
Collapse
|
5
|
Birgin E, Hartwig V, Rasbach E, Seyfried S, Rahbari M, Reeg A, Jentschura SL, Téoule P, Reißfelder C, Rahbari NN. Minimally invasive mesohepatectomy for centrally located liver lesions-a case series. Surg Endosc 2022; 36:8935-8942. [PMID: 35668311 PMCID: PMC9652264 DOI: 10.1007/s00464-022-09342-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/13/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Resection of centrally located liver lesions remains a technically demanding procedure. To date, there are limited data on the effectiveness and safety of minimally invasive mesohepatectomy for benign and malignant lesions. It was therefore the objective of this study to evaluate the perioperative outcomes of minimally invasive mesohepatectomy for liver tumors at a tertiary care hospital. METHODS Consecutive patients who underwent a minimally invasive anatomic mesohepatectomy using a Glissonean pedicle approach from April 2018 to November 2021 were identified from a prospective database. Demographics, operative details, and postoperative outcomes were analyzed using descriptive statistics for continuous and categorical variables. RESULTS A total of ten patients were included, of whom five patients had hepatocellular carcinoma, one patient had cholangiocarcinoma, three patients had colorectal liver metastases, and one patient had a hydatid cyst. Two and eight patients underwent robotic-assisted and laparoscopic resections, respectively. The median operative time was 393 min (interquartile range (IQR) 298-573 min). Conversion to laparotomy was required in one case. The median lesion size was 60 mm and all cases had negative resection margins on final histopathological analysis. The median total blood loss was 550 ml (IQR 413-850 ml). One patient had a grade III complication. The median length of stay was 7 days (IQR 5-12 days). Time-to-functional recovery was achieved after a median of 2 days (IQR 1-4 days). There were no readmissions within 90 days after surgery. CONCLUSION Minimally invasive mesohepatectomy is a feasible and safe approach in selected patients with benign and malignant liver lesions.
Collapse
Affiliation(s)
- Emrullah Birgin
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Vanessa Hartwig
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Erik Rasbach
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Steffen Seyfried
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Mohammad Rahbari
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Alina Reeg
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Sina-Luisa Jentschura
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Patrick Téoule
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christoph Reißfelder
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Nuh N. Rahbari
- grid.411778.c0000 0001 2162 1728Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| |
Collapse
|
6
|
Machado MA, Makdissi F, Surjan R. Laparoscopic glissonean approach: Making complex something easy or making suitable the unsuitable? Surg Oncol 2020; 33:196-200. [DOI: 10.1016/j.suronc.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 01/15/2023]
|
7
|
Laparoscopic Central Bisectionectomy and Right Anterior Sectionectomy Using Two Retraction Methods: Technical Aspects with Video. World J Surg 2019; 43:3120-3127. [DOI: 10.1007/s00268-019-05154-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
8
|
Laparoscopic versus open mesohepatectomy for patients with centrally located hepatocellular carcinoma: a propensity score matched analysis. Surg Endosc 2018; 33:2916-2926. [PMID: 30498855 DOI: 10.1007/s00464-018-6593-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic mesohepatectomy (LM) has been performed for patients with centrally located hepatocellular carcinoma (CL-HCC), its short- and long-term benefits compared with traditional open surgery remain unclear. The aim of the present study was to explore the independent role of LM in the prognosis of patients with CL-HCC. METHODS A retrospective analysis was undertaken of 348 patients who underwent mesohepatectomy for CL-HCC between January 2012 and October 2017 in our hospital. The impact of the surgical methods on long-term prognosis was evaluated by multivariable regression analysis. In addition, patients in the LM group were matched in a 1:3 ratio with open mesohepatectomy (OM) group. RESULTS Some 307 patients underwent OM and 41 had LM. In both adjusted and non-adjusted models, patients in LM group had similar overall survival (OS, both P > 0.05) and disease-free survival (DFS, both P > 0.05) compared to OM patients. The mean (s.d.) OS in LM and OM groups was 41.6 (7.2) and 46.4 (1.4) months, respectively. The mean (s.d.) DFS in LM and OM groups was 37.7 (5.9) and 33.4 (1.5) months, respectively. After propensity score-matched (PSM) analysis, 96 patients remained in OM group and 32 patients in LM group. In the PSM subset, patients in LM group still had comparable OS (P = 0.120) and DFS (P = 0.757) compared to patients in the OM group. After PSM, patients receiving LM had longer vascular exclusion time (P = 0.006) and shorter hospital stay (P = 0.004). In addition, LM was associated with reduced postoperative morbidity after PSM adjustment (P = 0.026). CONCLUSIONS LM is associated with fewer complications and does not compromise survival compared with OM. LM can be recommended as a safe and reasonable surgical option in selected patients with CL-HCC.
Collapse
|
9
|
Outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy for hepatocellular carcinoma: a propensity score matching analysis. Surg Endosc 2018; 33:1155-1166. [PMID: 30120583 DOI: 10.1007/s00464-018-6380-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/10/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few studies had been performed to concern the outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy (LGAH) for hepatocellular carcinoma (HCC). The aim of this study was to compare the outcomes of LGAH versus open Glissonian pedicle approach hepatectomy (OGAH) for HCC, especially in patients with cirrhosis. METHODS Hepatocellular carcinoma patients who underwent pure LGAH and OGAH between January 2015 and July 2017 in our institution were retrospectively enrolled in this study. Propensity score matching (PSM) of patients in a ratio of 1:1 was conducted to adjust the known confounders. The perioperative and oncological outcomes were compared between the two groups after PSM. RESULTS Some 80 patients underwent pure LGAH and 134 had OGAH. After PSM, 67 patients in each group were well matched for analysis. Both the postoperative overall complication rates (13.4% vs. 29.9%, P = 0.021) and mean comprehensive complication index (2.63 vs. 7.40, P = 0.035) were significantly lower in the LGAH group than those in OGAH group. Although the operative time was longer in the LRH group (P < 0.001), the length of postoperative hospital stay was shorter in the LRH group (P = 0.024). Furthermore, both the 3-year overall survival rate (73.3% for LGAH vs. 77.8% for OGAH, P = 0.338) and 3-year disease-free survival rate (56.4% for LGAH vs. 62.5% for OGAH, P = 0.455) were not significantly different between the groups. CONCLUSION Pure laparoscopic Glissonian approach may be a better alternative to open Glissonian approach in selected HCC patients, which provided fewer complications, shorter postoperative hospital stay and comparable oncological outcomes.
Collapse
|
10
|
Xiao Y, Li W, Wan H, Tan Y, Wu H. Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: A meta-analysis. Int J Surg 2018. [PMID: 29530828 DOI: 10.1016/j.ijsu.2018.02.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Both central hepatectomy (CH) and major hepatectomy (MH) are suggested surgical treatments for patients with centrally located hepatocellular carcinoma (CL-HCC). However, no consensus has been reached regarding which method is superior for managing these patients. This meta-analysis was conducted to compare the short- and long-term outcomes of CH and MH in patients with CL-HCC. METHODS An electronic search for studies published in all years up to July 2017 in PubMed (Medline), EMBASE, Cochrane Library and Web of Science was performed. The short-term outcome was the incidence of postoperative complications, and the long-term outcomes included 1-, 3- and 5-year overall survival (OS) and corresponding disease-free survival (DFS), mortality and morbidity. The results were presented as Risk Ratios (RRs) or weighted mean differences with 95% confidence intervals. RESULTS Four retrospective studies containing 465 patients with CL-HCC were included (248 in the CH group and 217 in the MH group). The results suggested no significant differences in the 1-, 3- and 5-year DFS, 1, 3 and 5-year OS, total morbidity or mortality between these groups. Nevertheless, the patients in the CH group presented a lower prevalence of vascular invasion (RR 0.70, 95% CI 0.52-0.93, P = 0.020) than did the MH group. In addition, CH led to a higher incidence of biliary fistula, while MH showed a higher incidence of postoperative liver failure. CONCLUSION This study demonstrated that the long-term outcomes of the patients with CL-HCC in these two groups were not significantly different. For short-term outcomes, CH resulted in a lower rate of postoperative liver failure, while MH resulted in a lower incidence of biliary fistula. Nonetheless, compared with MH, CH provided CL-HCC patients with greater future remnant liver volume without an increased risk of early intra-hepatic recurrence. More multi-centre, randomized controlled trials comparing the therapeutic efficacy of CH and MH are urgently warranted.
Collapse
Affiliation(s)
- Yang Xiao
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Li
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Haifeng Wan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yifei Tan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hong Wu
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
11
|
Updates and Critical Insights on Glissonian Approach in Liver Surgery. J Gastrointest Surg 2018; 22:154-163. [PMID: 29101722 DOI: 10.1007/s11605-017-3613-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
Abstract
Recent advances in surgical techniques have broadened the indications of surgical management of liver malignancies. Intraoperative bleeding is one of the known predictors of postoperative outcomes following liver surgery, signifying the importance of vascular control during liver resection. Furthermore, preservation of future liver remnant plays a critical role in prevention of post-hepatectomy liver failure as one of the main causes of postoperative morbidity and mortality. Glissonian approach liver resection offers an effective method for vascular inflow control while protecting future liver remnant from ischemia-reperfusion injury. Several studies have demonstrated the feasibility of Glisson's pedicle resection technique in modern liver surgery with an acceptable safety profile. Moreover, with increasing popularity of minimally invasive surgery, laparoscopic liver resection via Glissonian approach has been shown to be superior to standard laparoscopic hepatectomy. Herein, we systematically review the role of Glissonian approach hepatectomy in current practice of liver surgery, highlighting its advantages and disadvantaged over other methods of vascular control.
Collapse
|
12
|
Cho CW, Rhu J, Kwon CHD, Choi GS, Kim JM, Joh JW, Koh KC, Kim GS. Short-Term Outcomes of Totally Laparoscopic Central Hepatectomy and Right Anterior Sectionectomy for Centrally Located Tumors: A Case-Matched Study with Propensity Score Matching. World J Surg 2017; 41:2838-2846. [DOI: 10.1007/s00268-017-4105-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
Yan Y, Cai X, Geller DA. Laparoscopic Liver Resection: A Review of Current Status. J Laparoendosc Adv Surg Tech A 2017; 27:481-486. [DOI: 10.1089/lap.2016.0620] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yihe Yan
- Division of General Surgery, Department of Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xiaoyong Cai
- Division of General Surgery, Department of Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - David A. Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
14
|
Impact of Glissonean pedicle approach for centrally located hepatocellular carcinoma in mongolia. Int Surg 2016; 100:268-74. [PMID: 25692429 DOI: 10.9738/intsurg-d-14-00006.1] [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: 02/08/2023] Open
Abstract
Approaches to surgical resection of centrally located HCC remain controversial. Traditionally, hemi- or extended hepatectomy is suggested. However, it carries a high risk of postoperative complications in patients with cirrhosis. An alternative approach is Glissonean pedicle transection method. This study was conducted to assess the surgical and survival outcomes associated with central liver resection using the Glissonean pedicle transection. Sixty-nine patients with centrally located HCC were studied retrospectively. They were divided into conventional approach group with hemi- or extended hepatectomy, and Glissonean approach group with multisegmental central liver resection using the Glissonean pedicle transection. Glissonean pedicle transection method has comparable or superior surgical and survival outcomes to conventional hemi- or extended hepatectomy with regard to intraoperative bleeding, complications, hospital stay, and postoperative mortality and survival outcomes in patients with centrally located HCC. The 1-, 3-, and 5-year overall survival rates of the conventional approach group were 74%, 64%, and 55% respectively. For the Glissonean approach group, the 1 and 3-year overall survival rates were 86% and 61%, respectively. Glissonean pedicle transection method is a safe and effective surgical procedure in patients with centrally located HCC.
Collapse
|
15
|
Surjan RCT, Makdissi FF, Machado MAC. Anatomical basis for the intrahepatic glissonian approach during hepatectomies. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:128-31. [PMID: 26176251 PMCID: PMC4737336 DOI: 10.1590/s0102-67202015000200011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/24/2015] [Indexed: 11/22/2022]
Abstract
Background Anatomical liver resections are based on some basic technical principles such as
vascular control, ischemic area delineation to be resected and maximum parenchymal
preservation. These aspects are achieved by the intrahepatic glissonian approach,
which consists in accessing the pedicles of hepatic segments within the hepatic
parenchyma. Small incisions on well-defined anatomical landmarks are performed to
approach the pedicles, making dissection of the hilar plate unnecessary. Aim Analyze parameters in liver anatomy related to intrahepatic surgical technique to
glissonians pedicles, to set the normal anatomy related to the procedure and
thereby facilitate the attainment of this technique. Methods Anatomical parameters related to the intrahepatic glissonian approach were studied
in 37 cadavers. Measurements were performed with precision instruments. Data were
expressed as mean±standard deviation. The subjects were divided into groups
according to gender and liver weight and groups were compared statistically. Results Twenty-five cadavers were male and 12 female. No statistically significant
difference was observed in virtually all parameters when groups were compared.
This demonstrates the consistency of the anatomical parameters related to the
intrahepatic glissonian approach. Conclusion The results obtained in this study made possible major technical advances in the
realization of open and laparoscopic hepatectomies with intrahepatic glissonian
approach, and can help surgeons to perform liver resections by this method.
Collapse
|
16
|
Lee JH, Han G, Kim YJ, Jung MS, Choi D. A Technique for Simultaneous Cholecystectomy During Bariatric Surgery. JSLS 2015; 19:JSLS.2015.00072. [PMID: 26648677 PMCID: PMC4653580 DOI: 10.4293/jsls.2015.00072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Cholecystectomy performed during bariatric surgery is technically demanding. Herein is described a technique we term the Glissonian approach along with an evaluation of its effectiveness and safety. Methods: From April 1, 2009, through February 28, 2014, laparoscopic cholecystectomy was performed during laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 38 patients with proven cholecystopathy on diagnostic imaging. Perioperative outcomes were compared between the patients operated on with the Glissonian approach and those who underwent conventional laparoscopic cholecystectomy. Results: The Glissonian approach was adopted in 13 patients—11 during LRYGB and 2 during LSG—and the conventional operation was performed on 16 patients during LRYGB and 9 during LSG. Mean body mass indexes were 40.1 kg/m2 in the Glissonian-approach group and 37.6 kg/m2 in the conventional group. Laparoscopic cholecystectomy by the Glissonian approach saved a mean operative time of 7 minutes compared with the operative time of the conventional operation. No surgical complications related to cholecystectomy were noted in either group. Conclusion: This simple technique can be performed safely in morbidly obese patients, with low resultant morbidity and acceptable operation times.
Collapse
Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Guru Han
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yong Jin Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min-Sung Jung
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Dongho Choi
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Kanazawa A, Tsukamoto T, Shimizu S, Yamamoto S, Murata A, Kubo S. Laparoscopic Hepatectomy for Liver Cancer. Dig Dis 2015; 33:691-8. [PMID: 26397115 DOI: 10.1159/000438499] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This chapter covers a range of important topics of laparoscopic hepatectomy as a novel approach toward treatment of liver cancer. Although laparoscopic hepatectomy was performed in a limited number of centers in the 1990s, technological innovations, improvements in surgical techniques and accumulation of experience by surgeons have led to more rapid progress in laparoscopic hepatectomy in the late 2000s for minimally invasive hepatic surgery. Currently, laparoscopic hepatectomy can be performed for all tumor locations and several diseases via several approaches. The laparoscopic approach can be applied to several types of resection, not only for tumors but also for liver transplantation, with equivalent or better results compared with those obtained with open surgery. Therefore, laparoscopic hepatectomy will become a standard procedure for treatment of liver cancer in the near future.
Collapse
Affiliation(s)
- Akishige Kanazawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
| | | | | | | | | | | |
Collapse
|
18
|
Conrad C, Ogiso S, Inoue Y, Shivathirthan N, Gayet B. Laparoscopic parenchymal-sparing liver resection of lesions in the central segments: feasible, safe, and effective. Surg Endosc 2015; 29:2410-7. [PMID: 25391984 DOI: 10.1007/s00464-014-3924-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Here we report the first systematic evaluation of laparoscopic parenchymal-sparing segmentectomies for the resection of lesions in the central liver segments and the first series of laparoscopic mesohepatectomies. PATIENTS AND METHODS From 1995 to 2012, 482 laparoscopic hepatectomies were performed. Thirty-two patients underwent isolated resection of IVa and VIII, bisegmentectomies of IVa/IVb and V/VIII, or mesohepatectomy. Sixteen isolated resections of IVb or V were excluded. Data was extracted from a retrolective database and chart review. Complications were classified (Clavien-Dindo) by three independent surgeons. Seventeen patients had colorectal liver metastasis, four had neuroendocrine tumors, five had hepatocellular carcinoma, two had GIST, and one each had esophageal cancer, breast cancer, and melanoma. Fifteen patients underwent anatomic- and 17 non-anatomic wedge resection. Average blood loss was 403 cc (SD 475), and overall operative time was 183 (SD 106) for hepatectomy and 253 min (SD 94) for mesohepatectomies. Major complications were mainly attributable to synchronous procedures. Mortality, transfusion, and morbidity rates were 0, 12, and 37 %, respectively. CONCLUSION Parenchymal-sparing laparoscopic central liver resections and mesohepatectomies are feasible, safe, and effective if specific technical details we have learned over time are considered. Concomitant procedures should be an exception. This approach exhibits an alternative to open surgery while avoiding unnecessary sacrifice of functional parenchyma.
Collapse
Affiliation(s)
- Claudius Conrad
- Department of Digestive Pathology, Institute Mutulatiste Montsouris, Paris Descartes University, Paris, France,
| | | | | | | | | |
Collapse
|
19
|
Otsuka Y, Kaneko H, Cleary SP, Buell JF, Cai X, Wakabayashi G. What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:363-70. [PMID: 25631462 DOI: 10.1002/jhbp.216] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/18/2014] [Indexed: 12/25/2022]
Abstract
The continuing evolution of technique and devices used in laparoscopic liver resection (LLR) has allowed successful application of this minimally invasive surgery for the treatment of liver disease. However, the type of instruments by energy sources and technique used vary among each institution. We reviewed the literature to seek the best technique for parenchymal transection, which was proposed as one of the important clinical question in the 2nd International Consensus Conference on LLR held on October 2014. While publications have described transection techniques used in LLR from 1991 to June 2014, it is difficult to specify the best technique and device for laparoscopic hepatic parenchymal transection, owing to a lack of randomized trials with only a small number of comparative studies. However, it is clear that instruments should be used in combination with others based on their functions and the depth of liver resection. Most authors have reported using staplers to secure and divide major vessels. Preparation for prevention of unexpected hemorrhaging particularly in liver cirrhosis, the Pringle's maneuver and prompt technique for hemostasis should be performed. We conclude that hepatobiliary surgeons should select techniques based on their familiarity with a concrete understanding of instruments and individualize to the procedure of LLR.
Collapse
Affiliation(s)
- Yuichiro Otsuka
- Department of Surgery, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | | | | | | | | | | |
Collapse
|
20
|
Lee SY. Central hepatectomy for centrally located malignant liver tumors: A systematic review. World J Hepatol 2014; 6:347-357. [PMID: 24868328 PMCID: PMC4033292 DOI: 10.4254/wjh.v6.i5.347] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/23/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not.
METHODS: A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy.
RESULTS: A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle’s maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively.
CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserving procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.
Collapse
|
21
|
Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 2014; 28:2484-92. [PMID: 24622763 PMCID: PMC4077249 DOI: 10.1007/s00464-014-3469-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/24/2014] [Indexed: 12/31/2022]
Abstract
Background Hepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique. Methods Of 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010. Results Before the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P < 0.001). There were no conversions to open surgery, reoperations, or deaths. The semiprone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of S7 or S8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups. Conclusions Laparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00464-014-3469-y) contains supplementary material, which is available to authorized users.
Collapse
|
22
|
Machado MAC, Makdissi FF, Surjan RCT. Laparoscopic liver resection: personal experience with 107 cases. Rev Col Bras Cir 2014; 39:483-8. [PMID: 23348644 DOI: 10.1590/s0100-69912012000600007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/27/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To analyze our experience after 107 laparoscopic hepatectomies and discuss the technical evolution of laparoscopic hepatectomy in the last five years. METHODS Between April 2007 and April 2012 we performed 107 laparoscopic hepatectomies in 105 patients. The mean age was 53.9 years (17 to 85). Fifty-three patients were male. All interventions were performed by the authors. RESULTS from the total of 107 operations, there was need for conversion to open technique in three cases (2.8%). Sixteen patients (14.9%) had complications. Two patients died, a mortality of 1.87%. One death was due to massive myocardial infarction, unrelated to the procedure, which was uneventful and showed no conversion or bleeding. The other death was due to failure of the stapler. Twenty patients (18.7%) required blood transfusion. The most frequent type of hepatectomy was bisegmentectomy of segments 2-3, (33 cases), followed by right hepatectomy (22 cases). Seventy-two procedures (67.3%) were performed by the technique of Glissonian access. CONCLUSION The dissemination of results is of utmost importance. The technical difficulties, complications and even death, inherent in this complex type of surgery, need to be clearly disclosed. This procedure should be performed in a specialized center with knowledgeable staff. The technique of laparoscopic Glissonian access, described by our staff, facilitates the realization of anatomical hepatectomies.
Collapse
|
23
|
Mesohepatectomy: an emerging technique. Indian J Surg Oncol 2013; 4:345-8. [PMID: 24426755 DOI: 10.1007/s13193-013-0253-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 06/18/2013] [Indexed: 10/26/2022] Open
|
24
|
Ishii H, Ogino S, Ikemoto K, Toma A, Nakamura K, Itoh T, Ochiai T. Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma. World J Surg Oncol 2013; 11:82. [PMID: 23557004 PMCID: PMC3621591 DOI: 10.1186/1477-7819-11-82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/10/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mesohepatectomy with total resection of the caudate lobe and extrahepatic bile duct is sometimes performed for hilar cholangiocarcinoma or gallbladder carcinoma; however, only a few reports on mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma are available. METHODS A 71-year-old woman was preoperatively diagnosed with hepatocellular carcinoma in the central bisections (Couinaud's segments 4, 5, and 8) and the paracaval portion of the caudate lobe. Mesohepatectomy with total caudate lobectomy of the liver permitted the removal of tumors to provide a cancer-free raw surface of the liver. Mobilization of the caudate lobe is an important procedure in this surgery. Before the liver parenchyma was dissected, all short hepatic veins were ligated and divided from the left to the right side as the left lateral section was retracted to the right, and the caudate lobe branches of the portal vein and hepatic artery were ligated and divided. After the liver parenchymal dissection, both between the left lateral and medial sections and between the right anterior and posterior sections, the Glissonean branches of the caudate lobe were ligated and divided as the central bisections were anteriorly retracted. Finally, liver parenchymal dissection was performed between the caudate lobe and the right posterior section, which was along the right side of the inferior vena cava. RESULTS The surgery time was 538 minutes and blood loss was 1,207 mL. No blood transfusions were required during or after surgery. The postoperative course was uncomplicated. The patient is still alive 25 months after hepatectomy. CONCLUSION Although mesohepatectomy with total caudate lobectomy of the liver is technically more difficult than mesohepatectomy of the liver because the caudate lobe must be completely detached from the inferior vena cava and the hilar plate, it is a safe and effective treatment method in selected patients with hepatocellular carcinoma located at both the central bisections and the paracaval portion of the caudate lobe.
Collapse
Affiliation(s)
- Hiromichi Ishii
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Shinpei Ogino
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Koki Ikemoto
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Atsushi Toma
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Kenji Nakamura
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Tsuyoshi Itoh
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Toshiya Ochiai
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| |
Collapse
|
25
|
Recent progress in laparoscopic liver resection. Clin J Gastroenterol 2013; 6:8-15. [DOI: 10.1007/s12328-012-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
|