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Rhaiem R, Sommacale D, Zimmermann P, Amroun K, Tashkandi A, Laurent A, Amaddeo G, Calderaro J, Luciani A, Heurgue A, Thiefin G, Piardi T, Kianmanesh R, Brustia R. Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis. J Gastrointest Surg 2023; 27:2092-2102. [PMID: 37407897 DOI: 10.1007/s11605-023-05741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce. In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared. METHODS A retrospective inverse propensity score-weighted fashion (IPTW) case-control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed. RESULTS Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62-1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54-2.6, p = 0.66). After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence. CONCLUSION AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.
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Affiliation(s)
- Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France.
- Reims Champagne-Ardenne University, Reims, France.
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Daniele Sommacale
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Perrine Zimmermann
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Koceila Amroun
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Ahmad Tashkandi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Alexis Laurent
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Giuliana Amaddeo
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Julien Calderaro
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Pathology Department, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Alain Luciani
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Diagnostic Radiology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
| | - Alexandra Heurgue
- Reims Champagne-Ardenne University, Reims, France
- Department of Hepatology, Robert Debré University Hospital, Reims, France
| | - Gérard Thiefin
- Reims Champagne-Ardenne University, Reims, France
- Department of Hepatology, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
- Hepatobiliary, Pancreatic and Endocrine Surgery Department, Simon Veil Hospital, Troyes, France
| | - Reza Kianmanesh
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
- Reims Champagne-Ardenne University, Reims, France
| | - Raffaele Brustia
- INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France
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Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kitamura E, Kawano F. Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm. Turk J Surg 2022; 38:215-220. [PMID: 36846068 PMCID: PMC9948658 DOI: 10.47717/turkjsurg.2022.5731] [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: 03/25/2022] [Accepted: 07/31/2022] [Indexed: 12/24/2022]
Abstract
Objectives Hepatic transection through an anterior approach is required to successfully complete anatomical hepatectomy for large liver malignancies. The liver hanging maneuver (LHM) is an alternative procedure for transection on an adequate cut plane and may reduce intraoperative bleeding and transection times. Material and Methods We examined the medical records of 24 patients with large liver malignancies (>5 cm) who had undergone anatomical hepatic resection with LHM (n= 9) or without LHM (n= 15) between 2015 and 2020. Patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcomes were retrospectively compared between the LHM and non-LHM groups. Results The prevalence of tumors >10 cm was significantly higher in the LHM group than in the non-LHM group (p <0.05). Furthermore, LHM was significantly performed to right and extended right hepatectomies in the background normal liver (p <0.05). Although transection times did not significantly differ between the two groups, the amount of intraoperative blood loss was slightly lower in the LHM group than in the non-LHM group (1.566 mL vs. 2.017 mL), and blood transfusion was not needed for patients in the LHM group. Post-hepatectomy liver failure and bile leakage were not observed in LHM. However, the length of hospitalization was slightly shorter in the LHM group than in the non-LHM group. Conclusion LHM is useful for transecting an adequately cut plane in hepatectomy for liver tumors over 5 cm-in-size located on the right side and achieves better outcomes.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Masahide Hiyoshi
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya Imamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Koichi Yano
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Takeomi Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Eiji Kitamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Fumiya Kawano
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
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Aida T, Haruki K, Okui N, Yanagaki M, Onda S, Furukawa K, Shirai Y, Ikegami T. Triple liver hanging maneuver for hepatic central bisectionectomy with caudate lobectomy for resection of huge hepatocellular carcinoma (with video). Surg Today 2021; 52:866-869. [PMID: 34748070 DOI: 10.1007/s00595-021-02402-6] [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: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 10/19/2022]
Abstract
Resection of huge hepatocellular carcinomas occupying the central portion of the liver is challenging. Exposure of an adequate liver transection plane using an anterior approach is likely to be difficult because of compression by the tumor. We herein propose a "triple liver hanging maneuver" technique for central bisectionectomy with caudate lobectomy for huge hepatocellular carcinomas stretching the hilar plate and the right and left hepatic veins. In this technique, the first tape is introduced for the transection plane along the right side of the umbilical portion to the anterior surface of the inferior vena cava. The second tape is introduced to lift the paracaval caudate Glissonean pedicles from the hilar plate. The third tape is introduced for the transection plane along the right hepatic vein to the anterior surface of the inferior vena cava. The triple liver hanging maneuver could be effective for huge tumors compressing major hepatic vessels.
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Affiliation(s)
- Takashi Aida
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koichiro Haruki
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Norimitsu Okui
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mitsuru Yanagaki
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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