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Piron L, Deshayes E, Cassinotto C, Quenet F, Panaro F, Hermida M, Allimant C, Assenat E, Pageaux GP, Molinari N, Guiu B. Deportalization, Venous Congestion, Venous Deprivation: Serial Measurements of Volumes and Functions on Morphofunctional 99mTc-Mebrofenin SPECT-CT. Diagnostics (Basel) 2020; 11:diagnostics11010012. [PMID: 33374810 PMCID: PMC7823835 DOI: 10.3390/diagnostics11010012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
The objective was to assess the changes in regional volumes and functions under venous-impaired vascular conditions following liver preparation. Twelve patients underwent right portal vein embolization (PVE) (n = 5) or extended liver venous deprivation (eLVD, i.e., portal and right and middle hepatic veins embolization) (n = 7). Volume and function measurements of deportalized liver, venous-deprived liver and congestive liver were performed before and after PVE/eLVD at days 7, 14 and 21 using 99mTc-mebrofenin hepatobiliary scintigraphy with single-photon emission computed tomography and computed tomography (99mTc-mebrofenin SPECT-CT). Volume and function progressed independently in the deportalized liver (p = 0.47) with an early decrease in function (median −18.2% (IQR, −19.4–−14.5) at day 7) followed by a decrease in volume (−19.3% (−22.6–−14.4) at day 21). Volume and function progressed independently in the venous deprived liver (p = 0.80) with a marked and early decrease in function (−41.1% (−52.0–−12.9) at day 7) but minimal changes in volume (−4.7% (−10.4–+3.9) at day 21). Volume and function progressed independently in the congestive liver (p = 0.21) with a gradual increase in volume (+43.2% (+38.3–+51.2) at day 21) that preceded a late and moderate increase in function at day 21 (+34.8% (−8.3–+46.6)), concomitantly to the disappearance of hypoattenuated congestive areas in segment IV (S4) on CT, initially observed in 6/7 patients after eLVD and represented 35.3% (22.2–46.4) of whole S4 volume. Liver volume and function progress independently whatever the vascular condition. Hepatic congestion from outflow obstruction drives volume increase but results in early impaired function.
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Affiliation(s)
- Lauranne Piron
- Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France; (C.C.); (M.H.); (C.A.); (B.G.)
- Correspondence:
| | - Emmanuel Deshayes
- Department of Nuclear Medicine, Cancer Institute of Montpellier (ICM), 34090 Montpellier, France;
- Institute of Research Cancer of Montpellier (IRCM), INSERM U1194, Montpellier University, Cancer Institute of Montpellier (ICM), 34090 Montpellier, France
| | - Christophe Cassinotto
- Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France; (C.C.); (M.H.); (C.A.); (B.G.)
| | - François Quenet
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 34090 Montpellier, France;
| | - Fabrizio Panaro
- Division of HBP Surgery and Transplantation, Department of Surgery, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Margaux Hermida
- Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France; (C.C.); (M.H.); (C.A.); (B.G.)
| | - Carole Allimant
- Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France; (C.C.); (M.H.); (C.A.); (B.G.)
| | - Eric Assenat
- Department of Oncology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Georges-Philippe Pageaux
- Department of Hepatology and Liver Transplantation, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Nicolas Molinari
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34090 Montpellier, France;
| | - Boris Guiu
- Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France; (C.C.); (M.H.); (C.A.); (B.G.)
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Lee W, Cho JK, Jang JY, Hong SC, Jeong CY. Laparoscopic segmentectomy using ultrasound probe compression of hepatic vessel. Asian J Endosc Surg 2020; 13:423-425. [PMID: 31489775 DOI: 10.1111/ases.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 12/07/2022]
Abstract
Although open liver resection using ultrasound (US) probe compression of the hepatic vessel has been reported, laparoscopic liver resection using the same method has not yet been reported. Magnetic resonance imaging of a 55-year-old man with hepatitis B-related liver cirrhosis revealed a 2.5 cm liver mass in segment VI. He underwent laparoscopic segmentectomy. After right liver mobilization, the subglissonean pedicle of segment VI was identified and it was compressed with laparoscopic US probe with confirmation using Doppler US. The liver parenchyma was transected with a Cavitron ultrasonic surgical aspirator and advanced bipolar system along the ischemic line. The patient was discharged 9 days after surgery without complications. Laparoscopic segmentectomy using laparoscopic US probe compression has advantages including preservation of the hepatic parenchyma and prevention of injury to the adjacent Glissonean pedicle.
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Affiliation(s)
- Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, South Korea.,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of MedicineAsan Medical Center, Seoul, South Korea
| | - Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, South Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, South Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, South Korea
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Santambrogio R, Barabino M, Scifo G, Costa M, Giovenzana M, Opocher E. Effect of Age (over 75 Years) on Postoperative Complications and Survival in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2017; 21:657-665. [PMID: 28083840 DOI: 10.1007/s11605-016-3354-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thanks to technical advancement in surgery for hepatocellular carcinoma (HCC), hepatic resection (HR) for elderly HCC patients has become safer. However, elderly patients may have shorter long-term survival after surgery if compared with younger patients because of their expected life span. The aim of the present study was to evaluate clinical outcomes and safety after HR in HCC patients aged >75 years (older) compared with HCC patients aged <75 years (younger). METHOD One hundred sixty-eight patients who underwent HR for HCC from 1998 to 2015 in our Center were analyzed using a prospective database. Complications, disease-free survival rates, and cumulative survival rates were compared between the two groups. RESULTS During the immediate postoperative period, no differences were found about liver-related complications, hospital stay and 90-day mortality. However, older patients had more complications in class II or higher (Clavien classification) (p = 0.017). Although disease-free survival in both groups was similar (p = 0.099), overall survival was worse in the elderly group (p = 0.024). On multivariate analysis, only age ≥75 years was significantly related to overall survival. CONCLUSION If elderly patients with liver cirrhosis and HCC are appropriately selected and evaluated, they might have favorable prognoses after HR.
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Affiliation(s)
- Roberto Santambrogio
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy.
| | - Matteo Barabino
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Giovanna Scifo
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Mara Costa
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Marco Giovenzana
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
| | - Enrico Opocher
- UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy
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Li SQ, Hua YP, Shen SL, Hu WJ, Peng BG, Liang LJ. Segmental Bile Duct-Targeted Liver Resection for Right-Sided Intrahepatic Stones. Medicine (Baltimore) 2015; 94:e1158. [PMID: 26181559 PMCID: PMC4617081 DOI: 10.1097/md.0000000000001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatectomy is a safe and effective treatment for intrahepatic stones (IHSs). However, the resection plane for right-sided stones distributed within 2 segments is obstacle because of atrophy-hypertrophy complex formation of the liver and difficult dissection of segmental pedicle within the Glissonean plate by conventional approach. Thus, we devised segmental bile duct-targeted liver resection (SBDLR) for IHS, which aimed at completely resection of diseased bile ducts. This study aimed to evaluate the outcomes of SBDLR for right-sided IHSs. From January 2009 to December 2013, 107 patients with IHS treated by SBDLR in our center were reviewed in a prospective database. Patients' intermediate and long-term outcomes after SBDLR were analyzed. A total of 40 (37.4%) patients with localized right-sided stone and 67 (62.7%) patients with bilateral stones underwent SBDLR alone and SBDLR combined with left-sided hepatectomy, respectively. There was no hospital mortality of this cohort of patients. The postoperative morbidity was 35.5%. The mean intraoperative blood loss was 414 mL (range: 100-2500). Twenty-one (19.6%) patients needed red blood cells transfusion. The intermediate stone clearance rate was 94.4%; the final clearance rate reached 100% after subsequent postoperative cholangioscopic lithotomy. Only 2.8% patients developed stone recurrence in a median follow-up period of 38.3 months. SBDLR is a safe and effective treatment for right-sided IHS distributed within 2 segments. It is especially suitable for a subgroup of patients with bilateral stones whose right-sided stones are within 2 segments and bilateral liver resection is needed.
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Affiliation(s)
- Shao-Qiang Li
- From the Department of Hepatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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