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Olthof PB, Bouwense SAW, Bednarsch J, Dewulf M, Kazemier G, Maithel S, Jarnagin WR, Aldrighetti L, Roberts KJ, Troisi RI, Malago MM, Lang H, Alikhanov R, Ruzzenente A, Malik H, Charco R, Sparrelid E, Pratschke J, Cescon M, Nadalin S, Hagendoorn J, Schadde E, Hoogwater FJH, Schnitzbauer AA, Topal B, Lodge P, Olde Damink SWM, Neumann UP, Groot Koerkamp B. Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort. Ann Surg Oncol 2025; 32:1762-1768. [PMID: 39404989 PMCID: PMC11811460 DOI: 10.1245/s10434-024-16293-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 09/17/2024] [Indexed: 02/12/2025]
Abstract
BACKGROUND Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR. PATIENTS AND METHOD Patients who underwent major liver resection for pCCA at 27 centers were included. FTR was defined as the presence of a Dindo grade III or higher complication followed by death within 90 days after surgery. Liver failure ISGLS grade B/C were scored. Multivariable logistic analysis was performed to identify predictors of FTR and reported using odds ratio and 95% confidence intervals. RESULTS In the 2186 included patients, major morbidity rate was 49%, 90-day mortality rate 13%, and FTR occurred in 24% of patients with a grade III or higher complication. Across centers, major complication rate varied from 19 to 87%, 90-day mortality rate from 5 to 33%, and FTR ranged from 11 to 50% across hospitals. Age [1.04 (1.02-1.05) years], ASA 3 or 4 [1.40 (1.01-1.95)], jaundice at presentation [1.79 (1.16-2.76)], right-sided resection [1.45 (1.06-1.98)], and annual hospital volume < 6 [1.44 (1.07-1.94)] were positively associated with FTR. When liver failure is included, the odds ratio for FTR is 9.58 (6.76-13.68). CONCLUSION FTR occurred in 24% of patients after resection for pCCA. Liver failure was associated with a nine-fold increase of FTR and hospital volume below six was also associated with an increased risk of FTR.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jan Bednarsch
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, Universitats Klinikum Essen, Essen, Germany
| | - Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Shishir Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele Univeristy, Milan, Italy
| | - Keith J Roberts
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - Roberto I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital Naples, Naples, Italy
| | - Massimo M Malago
- Department of HPB- and Liver Transplantation Surgery, Royal Free Hospitals, University College London, London, UK
| | - Hauke Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center, Mainz, Germany
| | - Ruslan Alikhanov
- Department of Liver and Pancreatic Surgery, Department of Transplantation, Moscow Clinical Scientific Centre, Moscow, Russia
| | - Andrea Ruzzenente
- Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy
| | - Hassan Malik
- Liver Surgery Unit, Aintree University Hospital, Liverpool, UK
| | - Ramón Charco
- Department of HBP Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ernesto Sparrelid
- Division of Surgery and Oncology, Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matteo Cescon
- General Surgery and Transplant Unit, IRCCS- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Centre/Utrecht University, Utrecht, The Netherlands
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center Chicago, Chicago, IL, USA
| | | | - Andreas A Schnitzbauer
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Frankfurt, Germany
| | - Baki Topal
- Department of Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Peter Lodge
- Division of Surgery, Department of Hepatobiliary and Liver Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, Universitats Klinikum Essen, Essen, Germany
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Romic I, Separovic I, Grgic D, Petrovic I, Mavrek J, Silovski H. Reducing invasiveness in liver surgery-where is the limit? World J Gastrointest Surg 2025; 17:101852. [DOI: 10.4240/wjgs.v17.i2.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 11/29/2024] [Accepted: 12/31/2024] [Indexed: 01/22/2025] Open
Abstract
In this article, we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology Surgery. Most prominent advancements in liver surgery in the last two decades are related to refinements in surgical technique (extraglissonean approach) and advancements in surgical technology (laparoscopy and robotics). In this article, authors present both these aspects: Laparoscopic segmentectomy using extraglissonean approach. Furthermore, they describe segmental resections of all 8 segments which is the main novelty that can be observed in the article. By now, extraglissonean approach was thoroughly described mainly in hepatectomies or lateral sectionectomies. Various “hilar gates” are defined which allows safe liver resection by ligating Glissonean pedicles first which is then followed by parenchymal resection. We here focus on past, present and future perspectives of extraglissonean approach and laparoscopic liver resections and comment the value of the presented article.
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Affiliation(s)
- Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Ivan Separovic
- Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Dora Grgic
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Igor Petrovic
- Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Josip Mavrek
- Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Hrvoje Silovski
- Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
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Liu Z, Xia F, Guo B, Leng C, Zhang E, Xu L, Chen X, Zhu P. Comprehensive evaluation of the ramification patterns of hepatic vascular anatomy based on three-dimensional visualization technology. Updates Surg 2025:10.1007/s13304-025-02064-w. [PMID: 39853656 DOI: 10.1007/s13304-025-02064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/07/2025] [Indexed: 01/26/2025]
Abstract
The liver segmentation method proposed by Couinaud is widely accepted by surgeons because of its convenience and practicality. However, this conventional eight-segment classification does not reflect realistic details of the liver and thus requires further adjustments to promote improvements in surgical strategies. This study aimed to explore the ramification patterns of the hepatic vasculature comprehensively. A total of 197 eligible patients meeting the study criteria were enrolled for three-dimensional reconstruction analysis. In the left hemiliver, the portal vein bifurcated into P2 and umbilical portion (UP) in 172 (98.3%) patients. The P4b of 103 patients (103/172, 59.9%) whose P4b branched from the right horn of the left portal vein (LPV) diverged from the main trunk of the UP. In the right paramedian sector (RPMS), the entire portal trunk directly bifurcates into P8vent and P8dor. Simple branching of P5 off the trunk of the RPMS was observed in 78 patients (78/130, 60%). The anterior fissure vein (AFV) was identified in 86 (86/148, 58.1%) patients. V8d entered the right hepatic vein (RHV) in all the patients. In 75.3% (113/150) of all the patients, V5d joined the RHV. In the right lateral sector (RLS), more than half (71/133, 53.4%) of the patients had an arch-like type. We summarize different patterns of liver vascular branches, providing a valuable reference for clinical surgery and liver transplantation. Cranio-caudal segmentation is more common than ventral-dorsal segmentation. The AFV can be regarded as a reliable anatomical landmark for subsegmentation in segment 8. In addition, the absence of AFV was associated with the P8 pattern.
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Affiliation(s)
- Zhicheng Liu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Feng Xia
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Bin Guo
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Chao Leng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Erlei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Lei Xu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, China.
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Luo B, Wu SK, Zhang K, Wang PH, Chen WW, Fu N, Yang ZM, Hao JC. Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones. World J Gastrointest Surg 2024; 16:3133-3141. [PMID: 39575299 PMCID: PMC11577404 DOI: 10.4240/wjgs.v16.i10.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/23/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND For intrahepatic duct (IHD) stones, laparoscopic liver resection (LLR) is currently a reliable treatment. However, the current LLR difficulty scoring system (DSS) is only available for patients with hepatocellular carcinoma. AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability. METHODS We used clinical data from 80 patients who received LLR for IHD stones. Forty-six of these patients were used in multiple linear regression to construct a scoring system. Another 34 patients from different centers were used as external validation. The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients. RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort: Location of stones, number of stones ≥ 3, stones located in the bile ducts of several grades, previous biliary surgery less than twice, distal bile duct atrophy. Subsequently, the data set was validated using a DSS developed from the variables. The following variables were identified as statistically significant in external validation: Operative time, blood loss, intraoperative transfusion, postoperative alanine aminotransferase, and Clavien-Dindo grading ≥ 3. These variables demonstrated statistically significant differences in patients with three or more grades. CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty, and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.
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Affiliation(s)
- Bo Luo
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Si-Kai Wu
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Ke Zhang
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Pei-Hong Wang
- Department of General Surgery, The Western Theater Command General Hospital, Chengdu 610500, Sichuan Province, China
| | - Wei-Wei Chen
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Ning Fu
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Zhi-Ming Yang
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Jing-Cheng Hao
- Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
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Delvecchio A, Conticchio M, Inchingolo R, Ratti F, Magistri P, Belli A, Ceccarelli G, Izzo F, Spampinato MG, Angelis ND, Pessaux P, Piardi T, Di Benedetto F, Aldrighetti L, Memeo R. Robotic Major Hepatectomy in Elderly Patient. Cancers (Basel) 2024; 16:2083. [PMID: 38893202 PMCID: PMC11171148 DOI: 10.3390/cancers16112083] [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: 04/22/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND the role of minimally invasive liver surgery has been progressively developed, with the practice increasing in safety and feasibility also with respect to major liver resections. The aim of this study was to analyze the feasibility and safety of major liver resection in elderly patients. METHODS data from a multicentric retrospective database including 1070 consecutive robotic liver resections in nine European hospital centers were analyzed. Among these, 131 were major liver resections. Patients were also divided in two groups (<65 years old and ≥65 years old) and perioperative data were compared between the two groups. RESULTS a total of 131 patients were included in the study. Operative time was 332 ± 125 min. Postoperative overall complications occurred in 27.1% of patients. Severe complications (Clavien Dindo ≥ 3) were 9.9%. Hospital stay was 6.6 ± 5.3 days. Patients were divided into two groups based on their age: 75 patients < 65 years old and 56 patients ≥ 65 years old. Prolonged pain, lung infection, intensive care stay, and 90-day readmission were worse in the elderly group. The two groups were matched for ASA and Charlson comorbidity score and, after statistical adjustment, postoperative data were similar between two groups. CONCLUSIONS robotic major liver resection in elderly patients was associated with satisfying short-term outcomes.
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Affiliation(s)
- Antonella Delvecchio
- Unit of Hepato-Biliary and Pancreatic Surgery, “F. Miulli” General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy; (A.D.); (M.C.); (R.M.)
| | - Maria Conticchio
- Unit of Hepato-Biliary and Pancreatic Surgery, “F. Miulli” General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy; (A.D.); (M.C.); (R.M.)
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, “F. Miulli” General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (F.R.); (L.A.)
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, 20132 Milano, Italy
| | - Paolo Magistri
- Unit of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Modena and Reggio Emilia, 41121 Modena, Italy; (P.M.); (F.D.B.)
| | - Andrea Belli
- Unit of Hepato-Biliary and Pancreatic Surgery, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (F.I.)
| | - Graziano Ceccarelli
- Unit of General Surgery, San Giovanni Battista Hospital, USL Umbria 2, 06034 Foligno, Italy;
| | - Francesco Izzo
- Unit of Hepato-Biliary and Pancreatic Surgery, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy; (A.B.); (F.I.)
| | | | - Nicola De’ Angelis
- Unit of Digestive and Hepatobiliary Surgery, Centre Hospitalier Universitaire Henri Mondor, 94000 Créteil, France;
| | - Patrick Pessaux
- Department of Visceral and Digestive Surgery, Unit of Hepato-Bilio-Pancreatic Surgery, Nouvel Hospital Civil, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | - Tullio Piardi
- Unit of Surgery, Hôpital Robert Debré, 51100 Reims, France;
| | - Fabrizio Di Benedetto
- Unit of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Modena and Reggio Emilia, 41121 Modena, Italy; (P.M.); (F.D.B.)
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (F.R.); (L.A.)
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, 20132 Milano, Italy
| | - Riccardo Memeo
- Unit of Hepato-Biliary and Pancreatic Surgery, “F. Miulli” General Hospital, Acquaviva delle Fonti, 70021 Bari, Italy; (A.D.); (M.C.); (R.M.)
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Hoffman HT, Koch M, Witt RL, Ryan WR, Zenk J, Katz P, Rahmati R, Rassekh C, Donato F, McCulloch TM, Joshi AS, Chang JL, Gillespie MB, Pichardo PFA, Orloff LA, Marcelino A, Wenzel P, Cohen D, Fundakowski CE, Cognetti DM, Walvekar RR, Bertelli A, Quon H, Anderson C, Policeni B, Siegel G. Proposal for standardized ultrasound analysis of the salivary glands: Part 1 submandibular gland. Laryngoscope Investig Otolaryngol 2024; 9:e1224. [PMID: 38362174 PMCID: PMC10866606 DOI: 10.1002/lio2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.
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Affiliation(s)
| | | | - Robert Lee Witt
- Christiana Care/Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William R. Ryan
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Philippe Katz
- Institut d'Explorations Fonctionnelles des Glandes SalivairesParisFrance
| | | | - Christopher Rassekh
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | | | - Arjun S. Joshi
- The George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - M. Boyd Gillespie
- University of Tennessee Health Science Center College of MedicineMemphisTennesseeUSA
| | | | | | | | - Piper Wenzel
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - David Cohen
- Kaiser Permanente Los Angeles Medical CenterLos AngelesCaliforniaUSA
| | | | | | | | - Antonio Bertelli
- Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo BrazilSao PauloBrazil
| | - Harry Quon
- Johns Hopkins Medical Institutions CampusBaltimoreMarylandUSA
| | | | - Bruno Policeni
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Gordy Siegel
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Kazami Y, Kaneko J, Keshwani D, Kitamura Y, Takahashi R, Mihara Y, Ichida A, Kawaguchi Y, Akamatsu N, Hasegawa K. Two-step artificial intelligence algorithm for liver segmentation automates anatomic virtual hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1205-1217. [PMID: 37747080 DOI: 10.1002/jhbp.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Anatomic virtual hepatectomy with precise liver segmentation for hemilivers, sectors, or Couinaud's segments using conventional three-dimensional simulation is not automated and artificial intelligence (AI)-based algorithms have not yet been applied. METHODS Computed tomography data of 174 living-donor candidates for liver transplantation (training data) were used for developing a new two-step AI algorithm to automate liver segmentation that was validated in another 51 donors (validation data). The Pure-AI (no human intervention) and ground truth (GT, full human intervention) data groups were compared. RESULTS In the Pure-AI group, the median Dice coefficients of the right and left hemilivers were highly similar, 0.95 and 0.92, respectively; sectors, posterior to lateral: 0.86-0.92, and Couinaud's segments 1-8: 0.71-0.89. Labeling of the first-order branch as hemiliver, right or left portal vein perfectly matched; 92.8% of the second-order (sectors); 91.6% of third-order (segments) matched between the Pure-AI and GT data. CONCLUSIONS The two-step AI algorithm for liver segmentation automates anatomic virtual hepatectomy. The AI-based algorithm correctly divided all hemilivers, and more than 90% of the sectors and segments.
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Affiliation(s)
- Yusuke Kazami
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Deepak Keshwani
- Imaging Technology Center, Fujifilm Corporation, Tokyo, Japan
| | | | - Ryugen Takahashi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Ichida
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hepatobiliary scintigraphy to predict postoperative liver failure after major liver resection; a multicenter cohort study in 547 patients. HPB (Oxford) 2023; 25:417-424. [PMID: 36759303 DOI: 10.1016/j.hpb.2022.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND This study aimed to analyze the predictive value of Hepatobiliary scintigraphy (HBS) for posthepatectomy liver failure (PHLF) after major liver resection with a comparison to assessment of liver volume in a multicenter cohort. METHODS Patients who underwent liver resection after HBS were included from six centers. Remnant liver volume was calculated from CT images. PHLF was scored and graded according to the grade B/C ISGLS criteria. RESULTS In 547 patients PHLF incidence was 10% (56/547) and 90-day mortality rate 8% (42/547). Overall predictive value of remnant liver function was 0.66 (0.58-0.74) and similar to that of remnant volume (0.63 (0.72). For biliary tumors, a function cut-off of 2.7%/min/m2 and 30% volume cut-off resulted in a PHLF rate 12% and 13%, respectively. While an 8.5%/min (4.5%/min/m2) function cut-off resulted in 7% PHLF for those with a function above the cutoff while a 40% volume cutoff still resulted in 14% PHLF rate. In the multivariable analyses for PHLF, liver function was predictive but liver volume was not. CONCLUSION The current study shows that preoperative liver function assessment using HBS is at least as predictive for PHLF as liver volume assessment, and likely has several advantages, particularly in the high-risk sub-group of biliary tumors.
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Zhang X, Liu H, Hashimoto K, Yuan S, Zhang J. The gut–liver axis in sepsis: interaction mechanisms and therapeutic potential. Crit Care 2022; 26:213. [PMID: 35831877 PMCID: PMC9277879 DOI: 10.1186/s13054-022-04090-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/09/2022] [Indexed: 12/20/2022] Open
Abstract
Sepsis is a potentially fatal condition caused by dysregulation of the body's immune response to an infection. Sepsis-induced liver injury is considered a strong independent prognosticator of death in the critical care unit, and there is anatomic and accumulating epidemiologic evidence that demonstrates intimate cross talk between the gut and the liver. Intestinal barrier disruption and gut microbiota dysbiosis during sepsis result in translocation of intestinal pathogen-associated molecular patterns and damage-associated molecular patterns into the liver and systemic circulation. The liver is essential for regulating immune defense during systemic infections via mechanisms such as bacterial clearance, lipopolysaccharide detoxification, cytokine and acute-phase protein release, and inflammation metabolic regulation. When an inappropriate immune response or overwhelming inflammation occurs in the liver, the impaired capacity for pathogen clearance and hepatic metabolic disturbance can result in further impairment of the intestinal barrier and increased disruption of the composition and diversity of the gut microbiota. Therefore, interaction between the gut and liver is a potential therapeutic target. This review outlines the intimate gut–liver cross talk (gut–liver axis) in sepsis.
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10
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Azoulay D, Desterke C, Bhangui P, Salloum C, Conticchio M, Vibert E, Cherqui D, Adam R, Ichai P, Saliba F, Elmaleh A, Naili S, Lim C, Feray C. Tumors located in the central column of the liver are associated with increased surgical difficulty and postoperative complications following open liver resection for colorectal metastases. HPB (Oxford) 2022; 24:1376-1386. [PMID: 35437222 DOI: 10.1016/j.hpb.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/13/2022] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To assess the impact of difficult location (based on preoperative computed tomography) of liver metastases from colorectal cancer (LMCRC) on surgical difficulty, and occurrence of severe postoperative complications (POCs). METHODS A retrospective single-centre study of 911 consecutive patients with LMCRC who underwent hepatectomy by the open approach between 1998 and 2011, before implementation of laparoscopic surgery to obviate approach selection bias. LMCRC with at least one of the following four features on preoperative imaging: tumor invading the hepatocaval confluence or retro-hepatic inferior vena cava, centrally located (Segments 4,5,8) and >10 cm in diameter, abutting the supra-hilar area, or involving the paracaval portion or caudate process of Segment 1; were considered as topographically difficult (top-diff). Independent predictors of surgical difficulty assessed by number of blood units transfused, duration of ischemia, and number of sessions of pedicle clamping during surgery and of severe POCs were identified by multivariate analysis before, and after propensity score matching. RESULTS Top-diff tumor location independently predicted surgical difficulty. Severe POCs were associated with the tumor location [top-diff vs. topographically non difficult (non top-diff)], preoperative portal vein embolization, and variables related to surgical difficulty. CONCLUSION LMCRC in difficult location independently predicts surgical difficulty and severe POCs.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France.
| | - Christophe Desterke
- Université Paris-Saclay, Villejuif, France; Inserm UMR-S-MD A9, Hôpital Paul Brousse, Villejuif, France
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Chady Salloum
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Maria Conticchio
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - Philippe Ichai
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Annie Elmaleh
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Salima Naili
- Département D'Anesthésie-Réanimation, Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Chetana Lim
- Département de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Cyrille Feray
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
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11
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Garancini M, Scotti MA, Gianotti L, Rovere A, Uggeri F, Braga M, Romano F. Branching patterns of the left portal vein and consequent implications in liver surgery: The left anterior sector. Hepatobiliary Pancreat Dis Int 2022; 21:399-402. [PMID: 34274228 DOI: 10.1016/j.hbpd.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Mattia Garancini
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy.
| | - Mauro Alessandro Scotti
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
| | - Luca Gianotti
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
| | - Antonio Rovere
- Unit of Interventional Radiology, Department of Radiology, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
| | - Fabio Uggeri
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
| | - Marco Braga
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
| | - Fabrizio Romano
- Unit of Hepatobiliary Pancreatic Surgery, Department of General Surgery 1, ASST-Monza, San Gerardo Hospital, Milano-Bicocca University, via Pergolesi 33, 20900 Monza, MB, Italy
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12
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Rosati A, De Rose AM, Sala E, Giuliante F, Scambia G, Fagotti A. Ovarian cancer metastases in the liver area: proposal of a standardized anatomo-surgical classification. Int J Gynecol Cancer 2022; 32:955-956. [PMID: 35428689 DOI: 10.1136/ijgc-2021-003307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Andrea Rosati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Agostino Maria De Rose
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Evis Sala
- Department of Radiology, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Anna Fagotti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
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13
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Nazzal M, Madsen EC, Armstrong A, van Nispen J, Murali V, Song E, Voigt M, Madnawat H, Welu A, Manithody C, Suri A, Krebs J, Gilbert E, Samaddar A, Blackall D, Carpenter D, Varma C, Teckman J, Jain AK. Novel NMP split liver model recapitulates human IRI and demonstrates ferroptosis modulators as a new therapeutic strategy. Pediatr Transplant 2022; 26:e14164. [PMID: 34633130 DOI: 10.1111/petr.14164] [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: 06/10/2021] [Revised: 07/27/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Almost 9%of deceased donor livers are discarded as marginal donor livers (MDL) due to concern of severe ischemia reperfusion injury (IRI). Emerging data supports ferroptosis (iron regulated hepatocellular death) as an IRI driver, however lack of robust preclinical model limits therapeutic testing. In this manuscript we describe the development of a novel rigorous internal control system utilizing normothermic perfusion of split livers to test ferroptosis regulators modulating IRI. METHODS Upon institutional approval, split human MDLs were placed on our normothermic perfusion machine, Perfusion Regulated Organ Therapeutics with Enhanced Controlled Testing (PROTECT), pumping arterial and portal blood. Experiment 1 compared right (UR) and left (UL) lobes to validate PROTECT. Experiment 2 assessed ferroptosis regulator Deferoxamine in Deferoxamine Agent Treated (DMAT) vs. No Agent Internal Control (NAIC) lobes. Liver serology, histology, and ferroptosis genes were assessed. RESULTS Successful MDL perfusion validated PROTECT with no ALT or AST difference between UR and UL (∆ALT UR: 235, ∆ALT UL: 212; ∆AST UR: 576, ∆AST UL: 389). Liver injury markers increased in NAIC vs. DMAT (∆ALT NAIC: 586, ∆ALT DMAT: -405; ∆AST NAIC: 617, ∆AST DMAT: -380). UR and UL had similar expression of ferroptosis regulators RPL8,HO-1 and HIFα. Significantly decreased intrahepatic iron (p = .038), HO-1 and HIFα in DMAT (HO-1 NAIC: 6.93, HO-1 DMAT: 2.74; HIFαNAIC: 8.67, HIFαDMAT: 2.60)and no hepatocellular necrosis or immunohistochemical staining (Ki67/Cytokeratin-7) differences were noted. CONCLUSION PROTECT demonstrates the therapeutic utility of a novel normothermic perfusion split liver system for drug discovery and rapid translatability of therapeutics, driving a paradigm change in organ recovery and transplant medicine. Our study using human livers, provides preliminary proof of concept for the novel role of ferroptosis regulators in driving IRI.
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Affiliation(s)
- Mustafa Nazzal
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Erik C Madsen
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Austin Armstrong
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Johan van Nispen
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Vidul Murali
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Eric Song
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Marcus Voigt
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Himani Madnawat
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Adam Welu
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | | | - Anandini Suri
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Joseph Krebs
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ester Gilbert
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ashish Samaddar
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Douglas Blackall
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Danielle Carpenter
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Chintalapati Varma
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey Teckman
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.,Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ajay Kumar Jain
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.,Department of Pharmacology and Physiology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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14
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Serrano PE, Parpia S, Karanicolas P, Gallinger S, Wei AC, Simunovic M, Bhandari M, Levine M. Simultaneous resection for synchronous colorectal cancer liver metastases: A feasibility clinical trial. J Surg Oncol 2022; 125:671-677. [PMID: 34878649 PMCID: PMC9896571 DOI: 10.1002/jso.26764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES We tested the feasibility of a simultaneous resection clinical trial in patients with synchronous colorectal cancer liver metastases to obtain the necessary information to plan a randomized trial. METHODS Multicenter feasibility single-arm trial enrolling patients with synchronous colorectal cancer liver metastases eligible for simultaneous resection. Prespecified criteria for feasibility were: proportion of eligible patients enrolled ≥66%, and the proportion of enrolled patients who completed simultaneous resection ≥75%. The prespecified 90-day major postoperative complication rate was 30%. RESULTS Of 61 eligible patients from February 2017 to August 2019, 41 were enrolled (67%; 95% confidence interval [CI], 55%-78%), 32 underwent simultaneous resection (78%; 95% CI, 63%-88%). Four patients were not enrolled due to the surgeon's preference, three were due to the complexity of resection (right hepatectomy and low anterior resection). Intraoperative complications during liver resection (n = 4) and progression of disease (n = 4) were the main reasons for not undergoing simultaneous resection. The 90-day incidence of major complications was 41% (95% CI, 16%-58%) and the 90-day postoperative mortality was 6% (95% CI, 1.7%-20%). CONCLUSION According to prespecified criteria, enrolling patients with synchronous colorectal cancer liver metastases to a trial of simultaneous resection is feasible; however, it is associated with higher than anticipated 90-day postoperative complications.
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Affiliation(s)
- Pablo E. Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Paul Karanicolas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Steven Gallinger
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Alice C. Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York City, New York, USA
| | - Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark Levine
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario, Canada,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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15
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Wakabayashi G, Cherqui D, Geller DA, Abu Hilal M, Berardi G, Ciria R, Abe Y, Aoki T, Asbun HJ, Chan ACY, Chanwat R, Chen KH, Chen Y, Cheung TT, Fuks D, Gotohda N, Han HS, Hasegawa K, Hatano E, Honda G, Itano O, Iwashita Y, Kaneko H, Kato Y, Kim JH, Liu R, López-Ben S, Morimoto M, Monden K, Rotellar F, Sakamoto Y, Sugioka A, Yoshiizumi T, Akahoshi K, Alconchel F, Ariizumi S, Benedetti Cacciaguerra A, Durán M, Garcia Vazquez A, Golse N, Miyasaka Y, Mori Y, Ogiso S, Shirata C, Tomassini F, Urade T, Wakabayashi T, Nishino H, Hibi T, Kokudo N, Ohtsuka M, Ban D, Nagakawa Y, Ohtsuka T, Tanabe M, Nakamura M, Tsuchida A, Yamamoto M. The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:6-15. [PMID: 34866349 DOI: 10.1002/jhbp.1091] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Brisbane 2000 Terminology for Liver Anatomy and Resections, based on Couinaud's segments, did not address how to identify segmental borders and anatomic territories of less than one segment. Smaller anatomic resections including segmentectomies and subsegmentectomies, have not been well defined. The advent of minimally invasive liver resection has enhanced the possibilities of more precise resection due to a magnified view and reduced bleeding, and minimally invasive anatomic liver resection (MIALR) is becoming popular gradually. Therefore, there is a need for updating the Brisbane 2000 system, including anatomic segmentectomy or less. An online "Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (PAM-HBP Surgery Consensus)" was hosted on February 23, 2021. METHODS The Steering Committee invited 34 international experts from around the world. The Expert Committee (EC) selected 12 questions and two future research topics in the terminology session. The EC created seven tentative definitions and five recommendations based on the experts' opinions and the literature review performed by the Research Committee. Two Delphi Rounds finalized those definitions and recommendations. RESULTS This paper presents seven definitions and five recommendations regarding anatomic segmentectomy or less. In addition, two future research topics are discussed. CONCLUSIONS The PAM-HBP Surgery Consensus has presented the Tokyo 2020 Terminology for Liver Anatomy and Resections. The terminology has added definitions of liver anatomy and resections that were not defined in the Brisbane 2000 system.
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Affiliation(s)
- Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Paris, France
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mohammed Abu Hilal
- Department of Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Giammauro Berardi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, Spain
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Horacio J Asbun
- Hepato-Biliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Albert C Y Chan
- Division of Liver Transplantation, Hepatobiliary & Pancreatic Surgery, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Rawisak Chanwat
- Hepato-Pancreato-Biliary Surgery Unit, Department of Surgery, National Cancer Institute, Bangkok, Thailand
| | - Kuo-Hsin Chen
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yajin Chen
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - David Fuks
- Department of Digestive and Oncologic Surgery, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Goro Honda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hironori Kaneko
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yutaro Kato
- Department of Surgery, Fujita Health University, Aichi, Japan
| | - Ji Hoon Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Gyeonggi-do, Korea
| | - Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Santiago López-Ben
- General Surgery Department, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - Yoshihiro Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, Aichi, Japan
| | - Tomoharu Yoshiizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Felipe Alconchel
- Department of Surgery and Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Virgen de la Arrixaca), Murcia, Spain
| | - Shunichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Manuel Durán
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, Spain
| | | | - Nicolas Golse
- Hepatobiliary Center, Paul Brousse Hospital, Paris, France
| | - Yoshihiro Miyasaka
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ogiso
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hitoe Nishino
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takao Ohtsuka
- First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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16
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Sucandy I, Jacoby H, Crespo K, Syblis C, App S, Ignatius J, Ross S, Rosemurgy A. A Single Institution's Experience With Robotic Minor and Major Hepatectomy. Am Surg 2021:31348211047500. [PMID: 34798777 DOI: 10.1177/00031348211047500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Minimally invasive liver resection is gradually becoming the preferred technique to treat liver tumors due its salutary benefits when compared with traditional "open" method. While robotic technology improves surgeon dexterity to better perform complex operations, outcomes of robotic hepatectomy have not been adequately studied. We therefore describe our institutional experience with robotic minor and major hepatectomy. MATERIALS AND METHODS We prospectively study all patients undergoing robotic hepatectomy from 2016 to 2020. RESULTS A total of 220 patients underwent robotic hepatectomy. 138 (63%) were major hepatectomies while 82 (37%) were minor hepatectomies. Median age was 63 (62 ± 13) years, 118 (54%) were female. 168 patients had neoplastic disease and 52 patients had benign disease. Lesion size in patients who had undergone minor hepatectomy was 2 (3 ± 2.5) cm, compared to 5 (5 ± 3.0) cm in patients who undergone major hepatectomy (P < .001). 97% of patients underwent R0 resections while none of the patients had R2 resection. Operative duration was 226 (260 ± 122.7) vs 282 (299 ± 118.7) minutes (P ≤ .05); estimated blood loss was 100 (163 ± 259.2) vs 200 (251 ± 246.7) mL (P ≤ .05) for minor and major hepatectomy, respectively. One patient had intraoperative bleeding requiring "open" conversion. Nine (4%) patients had experienced notable postoperative complications and 2 (1%) patients died postoperatively. Length of stay was 3 (5 ± 4.6) vs 4 (5 ± 2.8) days for minor vs major hepatectomy (P = .84). Reoperation and readmission rate for minor vs major hepatectomy was 1% vs 3% (P = .65) and 9% vs 10% (P = .81), respectively. DISCUSSION Robotic major hepatectomy is safe, feasible, and efficacious with excellent postoperative outcomes.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Harel Jacoby
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Cameron Syblis
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Samantha App
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Joshua Ignatius
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
| | - Sharona Ross
- Digestive Health Institute, 4422AdventHealth Tampa, Tampa, FL, USA
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Modasi A, Sucandy I, Ross S, Krill E, Castro M, Lippert T, Luberice K, Rosemurgy A. The effect of diabetes on major robotic hepatectomy. J Robot Surg 2021; 16:137-142. [PMID: 33682066 DOI: 10.1007/s11701-021-01223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
Studies regarding the influence of diabetes on perioperative outcomes after major hepatectomy are conflicting. The objective of this study is to analyze the effects of diabetes on patients undergoing robotic major hepatectomy. With Institutional Review Board (IRB) approval, 94 patients undergoing major hepatectomy were prospectively followed. Demographic data and postoperative outcomes were analyzed and compared between diabetic and non-diabetic patients. Data were presented as median (mean ± SD). Patients were of age 62 (61 ± 13.0) years, BMI of 29 (29 ± 5.9) kg/m2, and ASA class of 3 (3 ± 0.55). The mass size was 5 (5 ± 3.0) cm. Operative duration was 252 (277 ± 106.6) min with estimated blood loss (EBL) was 175 (249 ± 275.9) mL. One operation was converted to 'open' due to bleeding, accounting for one intraoperative complication. Postoperatively, nine patients required ICU admission, with a duration of 1 (4 ± 5.9) day. Seven patients had postoperative complications. Length of stay (LOS) was 4 (4 ± 2.6) days. Fourteen patients were readmitted within 30 days. There were no deaths in-hospital or within 30 days. Of the 94 patients, 22 were diabetic and 72 were nondiabetic. Diabetic patients were older (70 (69 ± 11.3) years versus 58 (58 ± 12.4) years (p = 0.004)). Intraoperatively, operative duration, EBL, and complications were not significantly different. Postoperatively, LOS, ICU admission, ICU duration, complications, in-hospital mortality, readmission in 30 days, and death after 30 days showed no significant difference between diabetics and nondiabetics. In our experience, diabetes has no significant effect on perioperative outcomes after a robotic major hepatectomy.
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Affiliation(s)
- Aryan Modasi
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
- AdventHealth Tampa, 3000 Medical Park Drive Suite 500, Tampa, FL, 33613, USA.
| | - Sharona Ross
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Emily Krill
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Miguel Castro
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Trenton Lippert
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
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Zarfati A, Chambers G, Pio L, Guerin F, Fouquet V, Franchi-Abella S, Branchereau S. Management of focal nodular hyperplasia of the liver: Experience of 50 pediatric patients in a tertiary center. J Pediatr Surg 2020; 55:1885-1891. [PMID: 32057440 DOI: 10.1016/j.jpedsurg.2020.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/13/2019] [Accepted: 01/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a rare benign hepatic lesion in children. No management guidelines for pediatric population exist because of limited evidence. OBJECTIVE To review the experience of a large tertiary liver center, providing additional clinical data to help formulate management guidelines for FNH in the pediatric population. METHODS We analyzed data of children <18 years diagnosed with FNH from 1996 to 2018 at our hospital, detailing management and long-term clinical outcome. RESULTS 50 patients were identified. The median age was 10 years old (range 0.75-15.5 years old). The mean diameter of FNH was 5.9 cm (±3.1 cm). 10 patients had multiple lesions. First-line management: watchful waiting with serial checks (n = 37), surgery (n = 13). Of the watchful waiting patients, 10 required eventual second-line surgery. After a median follow-up of 4.7 years (range 0.5-20 years), 46 patients were asymptomatic, with no significant difference in clinical outcome (p = 0.962) between the two first-line management approaches. Lesions demonstrated growth in 13 cases: 5 of these required second-line surgery. In these patients, there was no significant difference in clinical outcome (p = 0.188) compared to nonoperative patients. Considering all surgically treated patients, there was no significant difference between first-line and second-line surgery for clinical outcome (p = 0.846), hospital stay (p = 0.410), complications (p = 0.510) and severe complications (p = 0.385). CONCLUSIONS Our data support the hypothesis that watchful waiting is a safe initial approach to pediatric FNH management in patients with no major symptoms or complications. Surgery should be reserved for patients with diagnostic doubt, persistent symptoms and/or biological or significant anatomical abnormalities. FNH growth alone should not be considered as an indication for surgery. TYPE OF STUDY Therapeutic study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Angelo Zarfati
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Greg Chambers
- Department of Pediatric Radiology, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Luca Pio
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Florent Guerin
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Virginie Fouquet
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Sophie Branchereau
- Department of Pediatric Surgery, Hôpitaux Universitaires Paris-Sud (AP-HP), Hôpital Bicêtre, 78, avenue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
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Sucandy I, Luberice K, Rivera-Espineira G, Krill E, Castro M, Bourdeau T, Ross S, Rosemurgy A. Robotic Major Hepatectomy: Influence of Age on Clinical Outcomes. Am Surg 2020; 87:114-119. [PMID: 32841058 DOI: 10.1177/0003134820945249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study was undertaken to determine if age influences postoperative outcomes for patients undergoing robotic major hepatectomy. METHODS Ninety-four patients undergoing robotic major hepatectomy were prospectively followed. With regression analysis, demographic data and postoperative outcomes were compared to age. Data are presented as median (mean ± SD). RESULTS Overall, the patients were of age 62 (61 ± 13) years, body mass index (BMI) of 29 (29 ± 5.9) kg/m2, and American Society of Anesthesiologists (ASA) class of 3 (3 ± 0.5). The mass size was 5 (5 ± 3.0) cm. The operative duration was 252 (276 ± 106) minutes with an estimated blood loss (EBL) of 175 (249 ± 275.9) mL. One operation was converted to "open" due to bleeding, accounting for the only intraoperative complication. Nine patients required intensive care unit (ICU) admission. Postoperatively, 7 patients had complications with no in-hospital mortalities, and a length of stay (LOS) of 4 (5 ± 2.6) days. Thirteen patients were readmitted within 30 days with 0 deaths within 30 days.A significant relationship was found between age and ASA class (P = .001) and LOS (P = .03). No correlation was found when comparing age to operative duration, EBL, ICU admission, ICU duration, complications, and readmission within 30 days. CONCLUSION For patients undergoing robotic major hepatectomy, there was no significant correlation between age and perioperative outcomes, with the exception of LOS. Increasing age is not associated with increased morbidity or perioperative mortality. With the application of innovative technology, that is, the robotic approach, surgeons should be encouraged to undertake major hepatectomy in elderly patients deemed candidates for surgery.
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Affiliation(s)
- Iswanto Sucandy
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
| | | | | | - Emily Krill
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Miguel Castro
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
| | | | - Sharona Ross
- Advent Health Tampa, Digestive Health Institute, Tampa, FL, USA
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Sucandy I, Luberice K, Lippert T, Castro M, Krill E, Ross S, Rosemurgy A. Robotic Major Hepatectomy: An Institutional Experience and Clinical Outcomes. Ann Surg Oncol 2020; 27:4970-4979. [DOI: 10.1245/s10434-020-08845-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
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Agostini A, Borgheresi A, Floridi C, Carotti M, Grazzini G, Pagnini F, Guerrini S, Palumbo P, Pradella S, Carrafiello G, Vivarelli M, Giovagnoni A. The role of imaging in surgical planning for liver resection: what the radiologist need to know. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:18-26. [PMID: 32945275 PMCID: PMC7944681 DOI: 10.23750/abm.v91i8-s.9938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
The management of patients undergoing surgical resection for liver malignancies requires a multidisciplinary team, including a dedicated radiologist. In the preoperative workup, the radiologist has to provide precise, relevant information to the surgeon. This requires the radiologist to know the basics of surgical techniques as well as liver surgical anatomy in order to help to avoid unexpected surgical scenarios and complications. Moreover, virtual resections and volumetries on radiological images will be discussed, and basic concepts of postoperative liver failure, regeneration, and methods for hypertrophy induction will be provided.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, AN, Italy; Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, AN, Italy.
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, AN, Italy.
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, AN, Italy; Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, AN, Italy.
| | - Marina Carotti
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, AN, Italy.
| | - Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCSS Ca Granda, Ospedale Maggiore Policlinico and Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Marco Vivarelli
- University Politecnica delle Marche, School of Medicine and University Hospital "Umberto I - Lancisi - Salesi", Division of Hepatobiliary and Transplant Surgery, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, AN, Italy; Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, AN, Italy.
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Rungsakulkij N, Vassanasiri W, Tangtawee P, Suragul W, Muangkaew P, Mingphruedhi S, Aeesoa S. Preoperative serum albumin is associated with intra-abdominal infection following major hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:479-489. [PMID: 31532926 PMCID: PMC6899963 DOI: 10.1002/jhbp.673] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Major hepatectomy is a complex surgical procedure with high morbidity. Intra‐abdominal infection (IAI) is common following hepatectomy and affects treatment outcomes. This study was performed to investigate perioperative factors and determine whether the preoperative serum albumin level is associated with IAI following major hepatectomy. Methods From January 2008 to December 2018, 268 patients underwent major hepatectomy. We retrospectively analyzed demographic data and preoperative and perioperative variables. IAI was defined as organ/space surgical site infection. Risk factors for IAI were analyzed by logistic regression analysis. Results In total, 268 patients were evaluated. IAI was observed in 38 patients (14.6%). The mortality rate in the IAI group was 15.7%. Multivariate logistic analysis confirmed that the serum albumin level (odds ratio 0.91; 95% confidence interval 0.84–0.97; P = 0.03) and operative duration (odds ratio 1.50; 95% confidence interval 1.18–1.91; P < 0.01) were independent factors associated with IAI. A logistic model using the serum albumin level and operative duration to estimate the probability of IAI was analyzed. The area under the receiver operating characteristic curve for predicting IAI was 0.78. Conclusion The serum albumin level and operative duration were independent factors predicting IAI following major hepatectomy.
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Affiliation(s)
- Narongsak Rungsakulkij
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Watoo Vassanasiri
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pongsatorn Tangtawee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Wikran Suragul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Paramin Muangkaew
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Somkit Mingphruedhi
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suraida Aeesoa
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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24
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Pellerin O, Pereira H, Van Ngoc Ty C, Moussa N, Del Giudice C, Pernot S, Déan C, Chatellier G, Sapoval M. Is dual-phase C-arm CBCT sufficiently accurate for the diagnosis of colorectal cancer liver metastasis during liver intra-arterial treatment? Eur Radiol 2019; 29:5253-5263. [PMID: 30937583 DOI: 10.1007/s00330-019-06173-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to estimate the accuracy of dual-phase C-arm cone beam computed tomography (CBCT) for the detection of colorectal cancer liver metastases, as compared with multidetector computed tomography (MDCT). MATERIALS AND METHODS Between March 2014 and December 2016, 49 consecutive patients referred for intra-arterial treatment for colorectal cancer liver metastases were enrolled in a single-center observational study. All patients were examined with MDCT and with dual-phase C-arm cone beam computed tomography performed after iodine injection in the proper hepatic artery before intra-arterial treatment. Two blinded observers independently reviewed all examinations. Diagnostic accuracy was determined using both a six-cell matrix method and a "worst-case scenario." RESULTS Readers identified at MDCT 264 colorectal liver metastases and 43 other liver lesions. The early and late arterial phase showed 240 and 277 liver lesions respectively. A certainty of the diagnosis was obtained in 63% and 85% at the early (EAP) and late arterial phase (LAP), respectively. Streak artifacts or liver segment truncation, or inadequate enhancement was responsible for the inability to see or to correctly adjudicate a lesion to a diagnosis in 27% and 15% of the cases at the EAP and LAP. The "worst-case scenario" yielded a Se and Sp of 58% and 51%, respectively, at EAP and 84% and 70%, respectively, at LAP. CONCLUSION On CBCT, EAP showed limited accuracy. LAP provided the best tumor detectability. KEY POINTS • The early arterial phase (EAP) yielded poor accuracy: Se = 58% and Sp = 51% (p < 0.0001). • The late arterial phase (LAP) phase yielded good accuracy: Se = 84% and Se = 70% (p = 0.02). • The probability of a correct diagnosis at the EAP was 60%.
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Affiliation(s)
- Olivier Pellerin
- INSERM U970, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Paris, France. .,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France.
| | - Helena Pereira
- Clinical Research Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM U1418, Paris, France
| | | | - Nadia Moussa
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Costantino Del Giudice
- INSERM U970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Simon Pernot
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Digestive Oncology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Carole Déan
- Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Gilles Chatellier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinical Research Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM U1418, Paris, France
| | - Marc Sapoval
- INSERM U970, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
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25
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Mungroop TH, Geerts BF, Veelo DP, Pawlik TM, Bonnet A, Lesurtel M, Reyntjens KM, Noji T, Liu C, Jonas E, Wu CL, de Santibañes E, Abu Hilal M, Hollmann MW, Besselink MG, van Gulik TM. Fluid and pain management in liver surgery (MILESTONE): A worldwide study among surgeons and anesthesiologists. Surgery 2019; 165:337-344. [DOI: 10.1016/j.surg.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/17/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
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Perihilar Glissonian Approach for Anatomical Parenchymal Sparing Liver Resections: Technical Aspects: The Taping Game. Ann Surg 2019; 267:537-543. [PMID: 27984211 DOI: 10.1097/sla.0000000000002100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To present technical details for central hepatectomy and right anterior and posterior sectionectomies using perihilar Glissonian approach for anatomical delineation and selective inflow occlusion. BACKGROUND Central tumors and those deeply located in the right liver may require extensive resections because of their proximity to major vascular structures. In such cases, anatomical more limited resections such as central hepatectomy or sectionectomies may provide an alternative to extensive surgery by assuring both parenchymal sparing and suitable oncologic resection. METHODS We present the global concept for performing a perihilar Glissonian approach and its application to each individual anatomical procedure. This includes detailed descriptions, illustrations, and videos demonstrating the technique. RESULTS This technique was applied since 1991 for anatomical parenchymal resections including central hepatectomy (resection of segments 4, 5, and 8), right anterior sectionectomy (resection of segments 5 and 8), and right posterior sectionectomy (resection of segments 6 and 7). The feasibility rate of the Glissonian approach was 88%. CONCLUSIONS Perihilar Glissonian approach is a safe and reproducible technique that enables anatomical parenchymal preserving liver resections for selected central and right-sided deeply located tumors.
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Zharikov YO, Kovalenko YA, Zharikova TS, Shkerdina MI, Nikolenko VN. [Surgical anatomy of liver segment iv and its importance in hepatobiliary surgery]. Khirurgiia (Mosk) 2019:93-99. [PMID: 31714537 DOI: 10.17116/hirurgia201911193] [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] [Indexed: 02/05/2023]
Abstract
The purpose of this article was to describe clinical anatomy of liver segment IV and determine its significance in liver resection surgery and within integrated approach in the treatment of malignancies of this area.
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Affiliation(s)
- Yu O Zharikov
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - Yu A Kovalenko
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - T S Zharikova
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - M I Shkerdina
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - V N Nikolenko
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia; Lomonosov Moscow State University, Moscow, Russia
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28
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Najah H, Ammar H, Gupta R, Hamdoun M, Morjane A, Mighri MM, Sassi S. Segmental branching pattern of the left portal vein: Anatomical characteristics and clinical implications. Clin Anat 2018; 31:1122-1128. [PMID: 29082657 DOI: 10.1002/ca.23009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/14/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022]
Abstract
The existing knowledge on anatomy of segmental branches of left portal vein (LPV) is limited. This study aims to describe the surgical anatomy and variations of LPV and its segmental branching pattern. Forty fresh cadaveric liver dissections were performed. The dissection of LPV was carried out from its emergence at the level of the portal vein bifurcation to its segmental branches penetrating the left hemiliver. LPV characteristics, the number, and situation of its segmental branches were recorded. LPV comprises two portions: a 28 ± 6.7 mm-long transverse portion (TPLPV) and a 34.9 ± 4.4 mm-long umbilical portion (UPLPV). Mean number of LPV branches to segments I, II, III, and IV was 2 ± 1 (1-6), 2 ± 1 (1-4), 2 ± 1 (1-5), and 8 ± 2 (4-14), respectively. A single large vein supplied segment II in 90% of the cases. Segment III constantly had one vein arising from the left horn of UPLPV with mean diameter of 5.9 ± 1.6 mm. Most of the veins to segment IV took origin from the right horn of UPLPV with a mean number of 5 ± 2 (2-8). Segmental veins arising from UPLPV and TPLPV and supplying segment IV were present in 90 and 45% of the cases respectively. Segmental veins arising from LPV are often multiple and variable in position. Detailed knowledge of these veins is mandatory in order successfully perform anatomical liver resections or monosegment graft harvest for pediatric liver transplantation. Clin. Anat. 31: 1122-1128, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Haythem Najah
- Department of General and Digestive Surgery, Hôpital Léon Binet, Route de Chalautre, Provins, France
| | - Houssem Ammar
- Department of General Surgery, Hôpital Ibn Jazzar, Kairouan, Tunisia
| | - Rahul Gupta
- Synergy Institute of Medical Sciences, Dehradun, India
| | - Moncef Hamdoun
- Department of Forensic Medicine, Hôpital Charles Nicolle, Tunis, Tunisia
- Université Tunis- El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La Rabta, Tunis, Tunisia
| | | | - Mohamed Mongi Mighri
- Université Tunis- El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La Rabta, Tunis, Tunisia
- Department of General Surgery, Hôpital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Sadok Sassi
- Université Tunis- El Manar, Faculté de Médecine de Tunis, 15 Rue Djebel Lakhdhar La Rabta, Tunis, Tunisia
- Department of General Surgery, Hôpital Mohamed Taher Maamouri, Nabeul, Tunisia
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Cazauran JB, Pâris L, Rousset P, Mercier F, Kepenekian V, Viste A, Passot G. Anatomy of the Right Anterior Sector of the Liver and Its Clinical Implications in Surgery. J Gastrointest Surg 2018; 22:1819-1831. [PMID: 29916108 DOI: 10.1007/s11605-018-3831-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/29/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgery remains the gold standard both for delimited hepatocellular carcinoma by selective anatomic liver segentectomy and for colorectal liver metastases by parenchymal sparing liver resection. Right anterior sector (RAS) (segments V-VIII; Couinaud) is the largest and most difficult sector to operate on. A better knowledge of its segmentation could prevent postoperative remnant liver ischemia and its impacts on patient's survival. METHODS A literature search was conducted in PubMed for papers on anatomy and surgery of the right anterior sector. RESULTS Segmentation of the RAS depended of the anatomic variations of the third-order portal branches. Cranio-caudal segmentation was the most commonly found (50-53%), followed by ventro-dorsal (23-26%), trifurcation (13-20%), and quadrifurcation types (5-11%). Ventral and dorsal partial or total subsegmentectomy seemed accessible in 47 to 50% of patients, including bifurcation, trifurcation, and quadrifurcation types, and could spare up to 22% of the total liver volume. The RAS hepatic vein was present in 85-100% of the patients and could be used as a landmark between RAS dorsal and ventral part in 63% of patients. Reported overall morbidity rate of RAS subsegmentectomy ranged from 33 to 59% among studies with a postoperative major complication rate (Clavien-Dindo ≥ III) ranging around 18% and a biliary leakage rate from 16 to 21%. In-hospital reported mortality rate was low (0-3%), and results were comparable to "classic" liver resections. RAS subsegmentectomy remains a complex procedure; median operating time ranged from 253 to 520 min and median intraoperative blood loss reached 1255 ml. CONCLUSION Better knowledge of RAS anatomy could allow for parenchymal preservation by using subsegmentectomy of the RAS, selective or as a part of a major hepatectomy.
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Affiliation(s)
- Jean-Baptiste Cazauran
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Lucas Pâris
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Pascal Rousset
- Hospices Civils de Lyon, Department of Radiology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France.,EMR 3738, Claude Bernard University, Lyon 1, Lyon, France
| | - Frédéric Mercier
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Vahan Kepenekian
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Anthony Viste
- Faculté de Médecine Lyon Sud-Charles Mérieux, Laboratoire d'Anatomie, Université de Lyon, Chemin du Petit Revoyet, 69600, Oullins, France.,Department of Orthopaedic Surgery, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Guillaume Passot
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. .,EMR 3738, Claude Bernard University, Lyon 1, Lyon, France.
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Li J, Mohamed M, Fischer L, Nashan B. Segment 5 parenchymal sparing in extended left hepatectomy with respect to venous outflow-is it a feasible procedure? Langenbecks Arch Surg 2018; 403:663-670. [PMID: 29956032 DOI: 10.1007/s00423-018-1673-2] [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: 12/27/2017] [Accepted: 04/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Segment 5 (S5) sparing liver resection for cases that require an anatomic left trisectionectomy has not been reported yet. The authors intended to verify the outcome of S5-sparing extended left hepatectomy (ELH) in respect to venous outflow. METHODS All adult patients who underwent S5-sparing ELH between 2012 and 2017 in authors' institute have been enrolled in this study. S5-sparring ELH was defined as resection of S2, S3, S4, and S8 with or without S1. The surgery planning was based on the images from two-dimensional triphasic computed tomography and/or magnetic resonance imaging. A three-dimensional image reconstruction and liver volumetric study were performed retrospectively. RESULTS Out of 177 cases of major hepatic resection, only seven non-hilar cholangiocarcinoma patients underwent ELH during the study period. S5-sparing ELH was performed to five patients, in whom no tumor involvement in S5. The venous outflow of S5 has been maintained intraoperative, and S5 congestion has not been observed in all patients. Tailored management of the S5 venous outflow ensured an increase in functional remnant liver volume by 52.8% (range, 25.6 to 66.9%) by sparing of S5. A negative resection margin was achieved in all patients. One patient had postoperative bile leak requiring reoperation. No posthepatectomy liver failure (PHLF) has been observed. CONCLUSION S5-sparing ELH is technically feasible. Under the tailored management of S5 venous outflow, the functional future liver remnant can be increased. Further studies with larger sample size are needed to evaluate which circumstances the liver segment 5 could be preserved without venous reconstruction during the left extended hepatectomy.
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Affiliation(s)
- Jun Li
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany.
| | - Moustafa Mohamed
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
| | - Björn Nashan
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246, Hamburg, Germany
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Koh YX, Tan HL, Lye WK, Kam JH, Chiow AKH, Tan SS, Choo SP, Chung AYF, Goh BKP. Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma: A critical appraisal of the evidence. World J Hepatol 2018; 10:433-447. [PMID: 29988922 PMCID: PMC6033716 DOI: 10.4254/wjh.v10.i6.433] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/10/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas (HCC). METHODS A systematic review of the published literature was performed using the PubMed database from 1st January 1999 to 31st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC. The primary end point was to determine the overall survival (OS) and disease free survival (DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve (i.e., Child's A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC (defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal HCC. RESULTS We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to (1) BCLC stage B or C HCC, (2) Size of HCC and (3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7% (range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0% (range 0.0-42.0). The collective median 5-year OS of both stages was 27.9% (0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR (95%CI) = 1.00 (0.76-1.31)] and mortality [RR (95%CI) = 1.15 (0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%. CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.
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Affiliation(s)
- Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore.
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Weng Kit Lye
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Juinn Huar Kam
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Adrian Kah Heng Chiow
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Siong San Tan
- Department of General Surgery, Hepatopancreatobiliary Service, Changi General Hospital, Singapore 529889, Singapore
| | - Su Pin Choo
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Alexander Yaw Fui Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169608, Singapore
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Surgical anatomy of the vasculobiliary apparatus at the hepatic hilum as applied to liver transplantations and major liver resections. J ANAT SOC INDIA 2018. [DOI: 10.1016/j.jasi.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Three-Dimensional Surgery Helps Liver Segmentectomy. J Am Coll Surg 2018; 226:939. [PMID: 29703347 DOI: 10.1016/j.jamcollsurg.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
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Towbin AJ, Meyers RL, Woodley H, Miyazaki O, Weldon CB, Morland B, Hiyama E, Czauderna P, Roebuck DJ, Tiao GM. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol 2018; 48:536-554. [PMID: 29427028 DOI: 10.1007/s00247-018-4078-z] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children's Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children's Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).
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Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Christopher B Weldon
- Departments of Surgery and Oncology, Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA, USA
| | - Bruce Morland
- Department of Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Greg M Tiao
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
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Felli E, Meniconi RL, Colasanti M, Vennarecci G, Ettorre GM. Complete resection of the hepatic veins: The role of right inferior vein. Hepatobiliary Pancreat Dis Int 2018; 17:88-90. [PMID: 29428112 DOI: 10.1016/j.hbpd.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/17/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Emanuele Felli
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy.
| | - Roberto L Meniconi
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Circ.ne Gianicolense 87, Rome 00152, Italy
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Serrano PE, Gafni A, Parpia S, Ruo L, Simunovic M, Meyers BM, Reiter H, Wei A, Gallinger S, Karanicolas P, Hallet J, Devaud N, Levine M. Simultaneous resection of colorectal cancer with synchronous liver metastases (RESECT), a pilot study. Int J Surg Protoc 2018; 8:1-6. [PMID: 31851740 PMCID: PMC6913566 DOI: 10.1016/j.isjp.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 01/14/2018] [Indexed: 12/11/2022] Open
Abstract
Traditionally, synchronous colorectal cancer and CRLM are resected separately. Many institutions have begun performing these procedures simultaneously. Minimal data support simultaneous resection including major liver resection. Complications will be investigated following simultaneous resection. This protocol will be implemented in 5 high-volume tertiary care centres worldwide. Introduction The “traditional approach” to resect synchronous colorectal cancer with liver metastases (CRLM) is to perform staged resections. Many institutions perform simultaneous resection. Disadvantages to the simultaneous approach include longer operating room times, which may increase major postoperative complication rates. Data supporting simultaneous resection are limited to retrospective studies that are subject to selection bias. Therefore, we have proposed a single-arm prospective cohort pilot study to evaluate the postoperative complications following simultaneous resection of synchronous CRLM. Methods and analysis This single-arm study will be performed in five high-volume hepatobiliary centres to prospectively evaluate the following objectives: (1) To determine the 90-day postoperative complication rate of patients diagnosed with synchronous CRLM undergoing a simultaneous colorectal and liver resection, including major liver resections; (2) To determine the postoperative mortality rate at 90 days following index surgery; (3) To determine change in global health-related Quality of Life (QoL) following simultaneous resection at three months compared to baseline; and (4) To build a costing model for simultaneous resection, We will also evaluate the feasibility of performing combined resection in these patients by evaluating the number of eligible patients enrolled in the study and determining the reasons eligible patients were not enrolled. This protocol has been registered with ClinicalTrials.gov (NCT02954913). Ethics and dissemination This study has been provincially approved by the central research ethics board. Study results will inform the design a randomized controlled trial by providing information about the comprehensive complication index in this patient population used to calculate the sample size for the trial.
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Affiliation(s)
- Pablo E. Serrano
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada
- Corresponding author at: Juravinski Hospital & Cancer Centre, 711 Concession St, B3 - Rm. 161, Hamilton, ON L8V 1C3, Canada.
| | - Amiram Gafni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada
| | - Leyo Ruo
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Marko Simunovic
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Brandon M. Meyers
- Department of Oncology, Division of Medical Oncology, McMaster University, Canada
| | - Harold Reiter
- Department of Oncology, Division of Radiation Oncology, McMaster University, Canada
| | - Alice Wei
- Department of General Surgery, Toronto General Hospital, University Health Network, University of Toronto, Canada
| | - Steven Gallinger
- Department of General Surgery, Toronto General Hospital, University Health Network, University of Toronto, Canada
- Department of General Surgery, Mount Sinai Hospital, University of Toronto, Canada
| | - Paul Karanicolas
- Department of Surgery Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Julie Hallet
- Department of Surgery Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - Mark Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Ontario Clinical Oncology Group, Hamilton, Ontario, Canada
- Department of Oncology, Division of Medical Oncology, McMaster University, Canada
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38
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Hikspoors JPJM, Peeters MMJP, Kruepunga N, Mekonen HK, Mommen GMC, Köhler SE, Lamers WH. Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry. Sci Rep 2017; 7:17109. [PMID: 29214994 PMCID: PMC5719430 DOI: 10.1038/s41598-017-16840-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022] Open
Abstract
Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular physiology on hepatic venous development. Human embryonic livers (5-10 weeks of development) were visualized with Amira 3D-reconstruction and Cinema 4D-remodeling software. Starting at 5 weeks, the portal and umbilical veins sprouted portal-vein branches that, at 6.5 weeks, had been pruned to 3 main branches in the right hemi-liver, whereas all (>10) persisted in the left hemi-liver. The asymmetric branching pattern of the umbilical vein resembled that of a "distributing" vessel, whereas the more symmetric branching of the portal trunk resembled a "delivering" vessel. At 6 weeks, 3-4 main hepatic-vein outlets drained into the inferior caval vein, of which that draining the caudate lobe formed the intrahepatic portion of the caval vein. More peripherally, 5-6 major tributaries drained both dorsolateral regions and the left and right ventromedial regions, implying a "crypto-lobar" distribution. Lobar boundaries, even in non-lobated human livers, and functional vascular requirements account for the predictable topography and branching pattern of the liver veins, respectively.
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Affiliation(s)
- Jill P J M Hikspoors
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Mathijs M J P Peeters
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Nutmethee Kruepunga
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
- Department of Anatomy, Faculty of Science, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand
| | - Hayelom K Mekonen
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Greet M C Mommen
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - S Eleonore Köhler
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
- NUTRIM Research School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Wouter H Lamers
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands.
- Tytgat Institute for Liver and Intestinal research, Academic Medical Center, Amsterdam, The Netherlands.
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Le Roy B, Gelli M, Pittau G, Allard MA, Pereira B, Serji B, Vibert E, Castaing D, Adam R, Cherqui D, Sa Cunha A. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg 2017; 105:839-847. [PMID: 28858392 DOI: 10.1002/bjs.10641] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 06/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Locoregional extension of intrahepatic cholangiocarcinoma (ICC) at the time of diagnosis results in a low resectability rate and poor prognosis. The aim of this retrospective study was to assess the efficacy of neoadjuvant chemotherapy for locally advanced ICC. METHODS All consecutive patients with ICC between 2000 and 2013 were included prospectively in a single-centre database and analysed retrospectively. Patients with locally advanced ICC considered as initially unresectable received primary chemotherapy, followed by surgery in those with secondary resectability. Results of patients who underwent surgery for locally advanced ICC were compared with those of patients with initially resectable ICC treated by surgery alone. RESULTS A total of 186 patients were included in the study. Of 74 patients with locally advanced ICC, 39 (53 per cent) underwent secondary resection after a median of six chemotherapy cycles. Patients in this group were younger (P = 0·030) and had more advanced disease than those who had surgery alone, and presented more frequently with lymphadenopathy (P = 0·010) and vascular invasion (P = 0·010). Postoperative morbidity and mortality were no different between the groups. The median survival of patients who had surgery after chemotherapy was 24·1 months, and that of patients who had surgery alone was 25·7 months (P = 0·391). CONCLUSION Patients with locally advanced ICC treated by surgery following neoadjuvant chemotherapy had similar short- and long-term results to patients with initially resectable ICC who had surgery alone. Neoadjuvant chemotherapy as a first-line treatment for locally advanced ICC may be an effective downstaging option, facilitating secondary resectability in patients with initially unresectable disease.
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Affiliation(s)
- B Le Roy
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France.,Service de Chirurgie Digestive, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - M Gelli
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - G Pittau
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - M-A Allard
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - B Pereira
- Biostatistics Unit (Direction de la Recherche Clinique et de l'Innovation), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - B Serji
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - E Vibert
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Castaing
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - R Adam
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Cherqui
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
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Cho JY, Han HS, Choi Y, Yoon YS, Kim S, Choi JK, Jang JS, Kwon SU, Kim H. Association of Remnant Liver Ischemia With Early Recurrence and Poor Survival After Liver Resection in Patients With Hepatocellular Carcinoma. JAMA Surg 2017; 152:386-392. [PMID: 28052154 DOI: 10.1001/jamasurg.2016.5040] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The remnant liver after hepatectomy may have inadequate blood supply, especially following nonanatomical resection or vascular damage. Objective To evaluate whether remnant liver ischemia (RLI) may have an adverse effect on long-term survival and morbidity after liver resection in patients with hepatocellular carcinoma. Design, Setting, and Participants This study was a retrospective analysis at Seoul National University Bundang Hospital. Remnant liver ischemia was graded on postoperative computed tomographic scans in 328 patients who underwent hepatectomy for hepatocellular carcinoma between January 1, 2004, and December 31, 2013. Main Outcomes and Measures Remnant liver ischemia was defined as reduced or absent contrast enhancement during the venous phase. Remnant liver ischemia was classified as minimal (none or marginal) or severe (partial, segmental, or necrotic). Results Among 328 patients (252 male and 76 female; age range, 26-83 years [mean age, 58.2 years]), radiologic signs of severe RLI were found in 98 patients (29.9%), of whom 63, 16, and 19 had partial, segmental, or necrotic RLI, respectively. These patients experienced more complications and longer hospital stay than patients with minimal RLI. Preoperative history of transarterial embolization (odds ratio [OR], 1.77; 95% CI, 1.02-3.03; P = .04), use of the Pringle maneuver (OR, 1.96; 95% CI, 1.08-3.58; P = .03), and longer operative time (OR, 1.003; 95% CI, 1.002-1.005; P < .001) were independent risk factors for severe RLI. Early recurrence rates within 6 (60.2% vs 9.6%) or 12 (79.6% vs 18.7%) months after hepatectomy were higher in patients with severe RLI than in patients without RLI (P < .001). Severe remnant liver ischemia was an independent risk factor for overall survival (OR, 6.98; 95% CI, 4.27-11.43; P < .001) and disease-free survival (OR, 5.15; 95% CI, 3.62-7.35; P < .001). Conclusions and Relevance Preventive management and technical refinements in hepatectomy are important to decrease the risk of RLI and to improve survival of patients with hepatocellular carcinoma.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Kyu Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Seong Jang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Uk Kwon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Zhang W, Tan Y, Jiang L, Yan L, Li B, Wen T, Yang J. Liver resection associated with better outcomes for single large hepatocellular carcinoma located in the same section. Medicine (Baltimore) 2017; 96:e6246. [PMID: 28272222 PMCID: PMC5348170 DOI: 10.1097/md.0000000000006246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The influence of the anatomical location of single large hepatocellular carcinoma (HCC) on outcomes following hepatic resection (HR) is still unclear. This study examined the role of anatomical location profiles as prognostic markers for patients with single large HCC undergoing HR.A total of 374 consecutive patients with single large HCC undergoing HR between January 2009 and July 2013 were included. They were divided into group same section (SS) group (n = 171) and different sections (DS) group (n = 203) according to their tumor's anatomical location. Short- and long-term outcomes were compared between the two groups.More patients in group DS had intraoperative blood loss of >1000 mL and needed intraoperative blood transfusion than those in group SS. There were no significant differences regarding postoperative complications and 30-and 90-day mortality between the two groups. The overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in group SS than group DS. The subgroup analysis showed that tumor in the same section was associated with better prognosis than those in different sections for both patients with tumor of ≤8 cm and of > 8 cm. Multivariate analysis revealed that age <60 years, portal hypertension, alpha-fetoprotein ≥400 ng/mL, tumor in different sections, microvascular invasion and poorly differentiated tumor are independent predictors of poor prognosis in patient with single large HCC.For patients with single large HCC, a tumor located in the same section may lead to better long-term survival and lower tumor recurrence rates than those in different sections following HR.
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Affiliation(s)
- Wei Zhang
- Department of Liver Surgery, Liver Transplantation Center
| | - Yongqiong Tan
- Center for Operating Room and Anesthesia, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Li Jiang
- Department of Liver Surgery, Liver Transplantation Center
| | - Lunan Yan
- Department of Liver Surgery, Liver Transplantation Center
| | - Bo Li
- Department of Liver Surgery, Liver Transplantation Center
| | - Tianfu Wen
- Department of Liver Surgery, Liver Transplantation Center
| | - Jiayin Yang
- Department of Liver Surgery, Liver Transplantation Center
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Iqbal S, Iqbal R, Iqbal F. Surgical Implications of Portal Vein Variations and Liver Segmentations: A Recent Update. J Clin Diagn Res 2017; 11:AE01-AE05. [PMID: 28384848 DOI: 10.7860/jcdr/2017/25028.9453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/28/2016] [Indexed: 12/30/2022]
Abstract
The Couinaud's liver segmentation is based on the identification of portal vein bifurcation and origin of hepatic veins. It is widely used clinically, because it is better suited for surgery and is more accurate in localizing and monitoring various intra parenchymal lesions. According to standard anatomy, the portal vein bifurcates into right and left branches; the left vein drains segment II, III and IV and the right vein divides into two secondary branches - the anterior portal vein drains segments V and VIII, and the posterior drains segments VI and VII. The portal vein variants such as portal trifurcation, with division of the main portal vein into the left, right anterior, and posterior branches, and the early origin of the right posterior branch directly from the main portal vein were found to be more frequent and was seen in about 20 - 35% of the population. Accurate knowledge of the portal variants and consequent variations in vascular segments are essential for intervention radiologists and transplant surgeons in the proper diagnosis during radiological investigations and in therapeutic applications such as preparation for biopsy, Portal Vein Embolization (PVE), Transjugular Intrahepatic Porto-Systemic Shunt (TIPS), tumour resection and partial hepatectomy for split or living donor transplantations. The advances in the knowledge will reduce intra and postoperative complications and avoid major catastrophic events. The purpose of the present review is to update the normal and variant portal venous anatomy and their implications in the liver segmentations, complex liver surgeries and various radiological intervention procedures.
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Affiliation(s)
- Showkathali Iqbal
- Professor, Department of Anatomy, Amala Institute of Medical Sciences , Amala Nagar, Thrissur, Kerala, India
| | - Raiz Iqbal
- Resident/House Surgeon/CRRI, Government Medical College , Kozhikode, Kerala, India
| | - Faiz Iqbal
- Student, Madras Medical College , Chennai, Tamil Nadu, India
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Postoperative peak transaminases correlate with morbidity and mortality after liver resection. HPB (Oxford) 2016; 18:915-921. [PMID: 27600437 PMCID: PMC5094483 DOI: 10.1016/j.hpb.2016.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transaminase levels are usually measured as markers of hepatocellular injury following liver resection, but recent evidence was unclear on their clinical value. This study aimed to identify factors that determine peak postoperative transaminase levels and correlated transaminase levels to postoperative complications. STUDY DESIGN All liver resections performed at a single center between 2006 and 2015 were included in the analysis. Multivariate analysis was used to identify factors that determine peak ALT and AST levels and postoperative morbidity and mortality. An ALT and AST cutoff for the prediction of mortality was determined using receiver operating characteristic curves analysis. RESULTS A total of 539 resections were included. Clavien-Dindo grade III or higher complications, intraoperative transfusion, and operative duration were identified as determinants of peak transaminases. A peak AST cut-off value for predicting mortality was defined at 828 U/L, with an area under the curve of 0.81 (0.73-0.89). The cut-off was an independent predictor of mortality (P < 0.01) along with (intraoperative) transfusion (P < 0.01), fifty-fifty criteria (P < 0.01), and age (P < 0.01). CONCLUSION Postoperative transaminase levels are independent predictors of postoperative morbidity and mortality and therefore clinically relevant. Transaminase levels usually peak during the first 24 h after surgery and thus possess early prognostic power in terms of postoperative mortality.
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Maurer R, Rivoire M, Basso V, Meeus P, Peyrat P, Dupré A. Portal supply of segment IV of the liver based on CT-scan. Surg Radiol Anat 2016; 39:471-476. [DOI: 10.1007/s00276-016-1761-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/13/2016] [Indexed: 01/27/2023]
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45
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Guerra S, Mamede AC, Carvalho MJ, Laranjo M, Tralhão JG, Abrantes AM, Maia CJ, Botelho MF. Liver diseases: what is known so far about the therapy with human amniotic membrane? Cell Tissue Bank 2016; 17:653-663. [PMID: 27550013 DOI: 10.1007/s10561-016-9579-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/13/2016] [Indexed: 01/20/2023]
Abstract
Liver, the largest intern organ of the human body, is responsible for several vital tasks such as digestive and excretory functions, as well as for nutrients storage and metabolic functions, synthesis of new molecules and purification of toxic chemicals. Cirrhosis, fibrosis and hepatocellular carcinoma are the most prevalent liver diseases. Despite all the studies performed so far, treatment options for these diseases are very limited. For this reason, it is urgent to find effective therapies for these pathologies. Several studies have been performed during the last decade about the possible application of human amniotic membrane in hepatic diseases therapy. Promising results about human amniotic membrane or its derived cells, in vitro and in vivo, applications in fibrosis, cirrhosis and hepatocellular carcinoma were already published. Since it is an attractive study area, it is becoming a dynamic scientific subject. However, the action mechanisms of human amniotic membrane and its derived cells in hepatic diseases therapy must be precisely known in order that this promising therapy could be clinically used.
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Affiliation(s)
- Sara Guerra
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal
| | - Ana Catarina Mamede
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal. .,CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal. .,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. .,CNC.IBILI, University of Coimbra, Coimbra, Portugal.
| | - Maria João Carvalho
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal.,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal.,Obstetrics Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Mafalda Laranjo
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal.,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - José Guilherme Tralhão
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal.,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Surgical Department A, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Margarida Abrantes
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal.,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Cláudio Jorge Maia
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Maria Filomena Botelho
- Biophysics Unit, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba - Celas, 3000-548, Coimbra, Portugal.,CIMAGO, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,CNC.IBILI, University of Coimbra, Coimbra, Portugal
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46
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Muangkaew P, Cho JY, Han HS, Yoon YS, Choi Y, Jang JY, Choi H, Jang JS, Kwon SU. Defining Surgical Difficulty According to the Perceived Complexity of Liver Resection: Validation of a Complexity Classification in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 2016; 23:2602-2609. [DOI: 10.1245/s10434-015-5058-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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47
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Abstract
This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.
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48
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Andraus W, Canedo BF, D'Alburquerque LAC. Living donor liver transplantation in Brazil-current state. Hepatobiliary Surg Nutr 2016; 5:176-82. [PMID: 27115012 DOI: 10.3978/j.issn.2304-3881.2015.12.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Currently in Brazil, living donor liver transplantation (LDLT) represents 8.5% of liver transplantation (LT), being the majority pediatric one. Up to now, according to Brazilian Organ Transplantation Association (ABTO) annual report, 2,086 procedures have been done nationwide, most of them in southeast and south regions. Based on national centers reports, biliary complication is the most common recipient postoperative complication (14.5-20.6%), followed by hepatic artery thrombosis (3.1-10.7%) and portal vein thrombosis (2.3-9.1%). Patient and graft overall 5-y survival correspond to 76% and 74%, respectively. Regarding the donor, morbidity rate ranges from 12.4% to 28.3%, with a national mortality rate of 0.14%. In conclusion, Brazilian LDLT programs enhance international experience that this is a feasible and safe procedure, as well as an excellent alternative strategy to overcome organs shortage.
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Affiliation(s)
- Wellington Andraus
- Discipline of Liver Transplant and Digestive Organs, Department of Gastroenterology, University of São Paulo School of Medicine, 01246-903 São Paulo, SP, Brazil
| | - Bernardo F Canedo
- Discipline of Liver Transplant and Digestive Organs, Department of Gastroenterology, University of São Paulo School of Medicine, 01246-903 São Paulo, SP, Brazil
| | - Luiz A C D'Alburquerque
- Discipline of Liver Transplant and Digestive Organs, Department of Gastroenterology, University of São Paulo School of Medicine, 01246-903 São Paulo, SP, Brazil
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49
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Hartog H, Ijzermans JN, van Gulik TM, Koerkamp BG. Resection of Perihilar Cholangiocarcinoma. Surg Clin North Am 2016; 96:247-67. [DOI: 10.1016/j.suc.2015.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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50
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Nitschke P, Bork U, Plodeck V, Podlesek D, Sobottka SB, Schackert G, Weitz J, Kirsch M. [Importance of preoperative and intraoperative imaging for operative strategies]. Chirurg 2016; 87:179-88. [PMID: 26939896 DOI: 10.1007/s00104-016-0163-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy.
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Affiliation(s)
- P Nitschke
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Bork
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - V Plodeck
- Institut für Radiologie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - D Podlesek
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S B Sobottka
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Schackert
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Kirsch
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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