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Laparoscopic liver resection for primary liver cancers originating in the paracaval portion of the caudate lobe: a preliminary retrospective analysis with 31 patients. Updates Surg 2021; 74:547-555. [PMID: 34586612 DOI: 10.1007/s13304-021-01170-9] [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: 01/20/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
Paracaval-originating cancers have been considered a contraindication for laparoscopic liver resection (LLR). This study aimed to explore the safety and feasibility of LLR in the treatment of paracaval-originating cancers. This study included 11 patients who underwent LLR and 20 who underwent open liver resection (OLR) for paracaval-originating cancers between May 2010 and November 2020. The outcomes of the procedures were retrospectively analyzed. There were no cases of perioperative death or conversion to laparotomy. The LLR group had an earlier postoperative feeding time, shorter postoperative hospital stay, and lower total bilirubin levels on the first day after surgery. No significant differences in the incidence of overall postoperative complications were noted between the LLR and OLR groups, but the incidence of grade IIIa complications was significantly higher in the LLR group than in the OLR group. Tumor recurrence occurred in 4 of 11 patients in the LLR group and in 11 of 20 patients in the OLR group. LLR for the treatment of paracaval-originating cancers is safe and feasible in selected patients.
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Sun TG, Wang XJ, Cao L, Li JW, Chen J, Li XS, Liao KX, Cao Y, Zheng SG. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos). Surg Endosc 2021; 35:5352-5358. [PMID: 33835250 DOI: 10.1007/s00464-021-08455-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The paracaval portion of the caudate lobe is located in the core of the liver. Lesions originating in the paracaval portion often cling to or even invade major hepatic vascular structures. The traditional open anterior hepatic transection approach has been adopted to treat paracaval-originating lesions. With the development of laparoscopic surgery, paracaval-originating lesions are no longer an absolute contraindication for laparoscopic liver resection. This study aimed to evaluate the safety and feasibility of laparoscopic anterior hepatic transection for resecting paracaval-originating lesions. METHODS This study included 15 patients who underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection between August 2017 and April 2020. The perioperative indicators, follow-up results, operative techniques and surgical indications were retrospectively evaluated. RESULTS All patients underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection. The median operation time was 305 min (220-740 min), the median intraoperative blood loss was 400 ml (250-3600 ml), and the median length of postoperative hospital stay was 9 days (5-20 days). No conversion to laparotomy or perioperative deaths occurred. Six patients had Clavien grade III-IV complications (III/IV, 5/1). Two patients developed tumor recurrence after 13 months and 8 months. CONCLUSION Although technically challenging, laparoscopic anterior hepatic transection is still a safe and feasible procedure for resecting paracaval-originating lesions in select patients.
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Affiliation(s)
- Tian-Ge Sun
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Xiao-Jun Wang
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Li Cao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian-Wei Li
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian Chen
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Xue-Song Li
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Ke-Xi Liao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Yong Cao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Shu-Guo Zheng
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.
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Deng HX, Huang JH, Lau WY, Ai F, Chen MS, Huang ZM, Zhang TQ, Zuo MX. Hydrochloric acid enhanced radiofrequency ablation for treatment of large hepatocellular carcinoma in the caudate lobe: Report of three cases. World J Clin Cases 2019; 7:508-515. [PMID: 30842963 PMCID: PMC6397810 DOI: 10.12998/wjcc.v7.i4.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To report on the use of percutaneous hydrochloric acid (HCl) enhanced radiofrequency ablation (HRFA) for the treatment of large (maximum diameter ≥ 5 cm) hepatocellular carcinoma (HCC) in the caudate lobe.
CASE SUMMARY Between August 2013 and June 2016, three patients with a large HCC (maximum diameter: 5.0, 5.7, and 8.1 cm) in the caudate lobe were treated by transarterial chemoembolization followed by computer tomography (CT) guided RFA using a monopolar perfusion RF electrode, which was enhanced by local infusion of 10% HCl at 0.2 mL/min (total volume, 3 to 12 mL). The output power of HRFA reached 100 W, and the average ablation time was 39 min (range, 15 to 60 min). Two patients each underwent one session of HRFA and one patient two sessions. After treatment, CT/magnetic resonance imaging showed that all the three lesions were completely ablated. There was no major complication. Two patients had asymptomatic bile duct dilatation. One patient died of tongue cancer 24 mo after ablation. The remaining two patients were alive and no area of enhancement is detected in the caudate lobe at 28 and 60 mo after ablation, respectively.
CONCLUSION Percutaneous CT-guided HRFA is safe and efficacious in treating large HCC in the caudate lobe.
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Affiliation(s)
- Han-Xia Deng
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Fei Ai
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Min-Shan Chen
- Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Zhi-Mei Huang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Meng-Xuan Zuo
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
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Chung YK, Hwang S, Ko GY, Yoon SM. Long-term complete response after transcatheter arterial chemoembolization and stereotactic body radiation therapy in a patient with hepatocellular carcinoma at the caudate lobe. Ann Hepatobiliary Pancreat Surg 2018; 22:274-281. [PMID: 30215050 PMCID: PMC6125267 DOI: 10.14701/ahbps.2018.22.3.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/01/2018] [Accepted: 06/29/2018] [Indexed: 12/28/2022] Open
Abstract
It is expected that a combination of transcatheter arterial chemoembolization (TACE) with stereotactic body radiation therapy (SBRT) may induce synergistic therapeutic effects in hepatocellular carcinoma (HCC), which would result in a high rate of complete therapeutic response. In this study, we present the 5-year clinical course of a patient who had HCC at the caudate lobe, which was treated with TACE and SBRT. A 53-year-old male was diagnosed with an 8 cm-sized HCC at the caudate lobe with compression of the inferior vena cava (IVC). For fear of pulmonary metastasis, we decided to perform sequential TACE-radiotherapy instead of upfront hepatectomy, although the tumor appeared resectable. The first session of TACE, SBRT with 12 fractions, and the second session of TACE were sequentially performed. The patient was administered metformin for chemoprevention. Over the course of a 5-year follow-up, there was no evidence of HCC recurrence. We reported the clinical sequence of a patient showing complete therapeutic response of HCC at the caudate lobe after a combination of TACE and radiotherapy. This type of combined locoregional treatment can be a therapeutic option for HCC at the caudate lobe with marginal resectability.
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Affiliation(s)
- Yong-Kyu Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhang F, Zhang J, Li X, Li B, Tao K, Yue S. Notch signaling pathway regulates cell cycle in proliferating hepatocytes involved in liver regeneration. J Gastroenterol Hepatol 2018; 33:1538-1547. [PMID: 29384233 DOI: 10.1111/jgh.14110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/11/2018] [Accepted: 01/22/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM It has been well documented that Notch signaling is involved in liver regeneration. However, the exact molecular mechanism mediating this process is not fully elucidated. The current study aimed to investigate the role of Notch signaling regulating cell cycle in proliferating hepatocytes in liver regeneration after partial hepatectomy (PHx, 67% resection) and the related molecular mechanism. METHODS Partial hepatectomy was performed in Sprague Dawley rats, and remnant livers were harvested 0, 1, 3, 5, and 7 days after operation, and primary hepatocytes were isolated to investigate the molecular mechanism. RESULTS Notch signaling activation and hepatocyte proliferation were significantly increased after PHx, while treatment with FLI-06, the inhibitor of γ-secreting enzyme, blocked these trends. Besides, inhibition of Notch signaling led to dysregulation of cell cycle and cell-cycle components. Furthermore, Akti-1/2 (a selective Akt inhibitor) and PX-478 (a selective Hif-1α inhibitor) inhibited hepatocyte proliferation and liver regeneration after PHx, and the effect of downstream molecules activation by Jagged-1 (Notch-1 ligand) in hepatocytes was abolished by FLI-06, Akti-1/2, and PX-478. CONCLUSION The current study demonstrated for the first time that Notch signaling regulated cell cycle in proliferating hepatocytes involved in liver regeneration through NICD/Akt Akt/Hif-1α pathway.
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Affiliation(s)
- Fen Zhang
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jinglong Zhang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xiao Li
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Bowei Li
- Department of 2nd Surgery, Baoji City Chinese Medicine Hospital, Baoji, Shanxi, China
| | - Kaishan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Shuqiang Yue
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Fernandes EDSM, Pacilio CA, de Mello FPT, de Oliveira Andrade R, Pimentel LMS, Girão CL. Anterior transhepatic approach for total caudate lobectomy including spigelian lobe, paracaval portion and caudate process: A Brazilian experience. Hepatobiliary Pancreat Dis Int 2018; 17:371-373. [PMID: 30049478 DOI: 10.1016/j.hbpd.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Eduardo de Souza Martins Fernandes
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil; Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carlo Alberto Pacilio
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil.
| | | | | | | | - Camila Liberato Girão
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil
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Ventral approach for resecting hepatocellular carcinoma in the caval portion of the caudate lobe. Surgery 2018; 163:1245-1249. [PMID: 29475614 DOI: 10.1016/j.surg.2018.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 01/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resection of hepatocellular carcinoma located in the caudate lobe is challenging because this anatomical location is difficult to approach, especially the caval portion. METHODS We performed resection of the caval portion of the caudate lobe using a ventral approach combined with the resection of segment IV, VII, or VIII for hepatocellular carcinoma in 41 patients (extended segmentectomy group). As a control group, 138 patients with hepatocellular carcinoma who underwent segmentectomy for IV, VII, or VIII (segmentectomy group) were studied. We compared surgical outcomes, including postoperative morbidity and survival, between the 2 groups. RESULTS When compared with the segmentectomy group, platelet count was lower (12.8 × 104/µL [range, 2.4-33.8] vs 14.8 × 104/µL [3.2-41.4], P = .085), operation time was significantly longer (442 minutes [range, 184-710] vs 333 minutes [131-810], P < .001), blood loss was significantly greater (579 mL [range, 25-2688] vs 301 mL [10-3887], P = .001), and the percentage of patients with cirrhosis was greater (19 [46.3%] vs 41 [29.7%], P = .059) in the extended segmentectomy group. However, the morbidity rate (48.7% and 33.3%, P = .096) and median overall survival period (5.2 years; [95% confidence interval, 4.6-6.6] vs 6.2 years, [5.4-9.7], P = .203) were not significantly different between the 2 groups. CONCLUSION The ventral approach for the resection of hepatocellular carcinoma in the caval portion of the caudate lobe is a viable alternative to other approaches, especially in patients with insufficient liver function.
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Hong DF, Liu YB, Peng SY, Pang JZ, Wang ZF, Cheng J, Shen GL, Zhang YB. Management of hepatocellular carcinoma rupture in the caudate lobe. World J Gastroenterol 2015; 21:8163-8169. [PMID: 26185390 PMCID: PMC4499361 DOI: 10.3748/wjg.v21.i26.8163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/22/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To demonstrate that caudate lobectomy is a valid treatment in cases of hepatocellular carcinoma (HCC) rupture in the caudate lobe based on our experience with the largest case series reported to date.
METHODS: A retrospective study of eight patients presenting with spontaneous rupture and hemorrhage of HCC in the caudate lobe was conducted. Two patients underwent ineffective transarterial embolization preoperatively. Caudate lobectomy was performed in all eight patients. Bilateral approach was taken in seven cases for isolated complete caudate lobectomy. Left-sided approach was employed in one case for isolated partial caudate lobectomy. Transarterial chemoembolization was performed postoperatively in all patients.
RESULTS: Caudate lobectomy was successfully completed in all eight cases. The median time delay from the diagnosis to operation was 5 d (range: 0.25-9). Median operating time was 200 min (range: 120-310) with a median blood loss of 900 mL (range: 300-1500). Five patient remained in long-term follow-up, with one patient becoming lost to follow-up at 3 years and two patients currently alive at 7 and 19 mo. One patient required reoperation due to recurrence. Gamma knife intervention was performed for brain metastasis in another case. Two patients survived for 10 and 84 mo postoperatively, ultimately succumbing to multiple organ metastases.
CONCLUSION: Caudate lobectomy is the salvage choice for HCC rupture in the caudate lobe. Local anatomy and physiologic features of the disease render caudate lobectomy a technically difficult operation. Postponement of surgical intervention is thus recommended while the rupture remains hemodynamically stable until an experienced surgeon becomes available. Prognosis is confounded by numerous factors, but long-term survival can be expected in the majority of cases.
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