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Hosoda K, Umemura K, Shimizu A, Kubota K, Notake T, Kitagawa N, Sakai H, Hayashi H, Yasukawa K, Soejima Y. The platelet-to-lymphocyte ratio is a complementary prognostic factor to tumor markers in predicting early recurrence of hepatocellular carcinoma after hepatectomy. J Surg Oncol 2024; 129:765-774. [PMID: 38105473 DOI: 10.1002/jso.27564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The usefulness of inflammation-based prognostic scores for early recurrence (ER) after hepatectomy for hepatocellular carcinoma has rarely been reported. This study aimed to evaluate the potential of inflammation-based prognostic scores as predictors of ER and their relationship with tumor markers. METHODS We enrolled 338 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2021. Clinicopathological factors were compared between patients who developed ER (ER group) and those who did not develop ER (non-ER group). The association between inflammation-based prognostic scores and ER status was evaluated. These scores were compared with those of well-established tumor markers. RESULTS The platelet-to-lymphocyte ratio (PLR) correlated with ER of hepatocellular carcinoma, with an area under the curve (AUC) value of 0.70, sensitivity of 68.1%, and specificity of 67.7%. In patients with low tumor marker levels, the PLR showed a strong correlation with ER of hepatocellular carcinoma, with an AUC value of 0.851, sensitivity of 100%, and specificity of 76.2%. Multivariate analysis revealed that the PLR was an independent prognostic factor for ER. CONCLUSIONS The PLR is useful and complementary to tumor markers for predicting ER after hepatectomy for hepatocellular carcinoma.
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Affiliation(s)
- Kiyotaka Hosoda
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Umemura
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Shimizu
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koji Kubota
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsuyoshi Notake
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Noriyuki Kitagawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroki Sakai
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hikaru Hayashi
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koya Yasukawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Chandra P, Sacks GD. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel) 2024; 16:941. [PMID: 38473303 DOI: 10.3390/cancers16050941] [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: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.
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Affiliation(s)
- Pratik Chandra
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- VA New York Harbor Healthcare System, New York, NY 10010, USA
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Wakabayashi T, Benedetti Cacciaguerra A, Ciria R, Ariizumi S, Durán M, Golse N, Ogiso S, Abe Y, Aoki T, Hatano E, Itano O, Sakamoto Y, Yoshizumi T, Yamamoto M, Wakabayashi G. Landmarks to identify segmental borders of the liver: A review prepared for PAM-HBP expert consensus meeting 2021. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:82-98. [PMID: 33484112 DOI: 10.1002/jhbp.899] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In preparation for the upcoming consensus meeting in Tokyo in 2021, this systematic review aimed to analyze the current available evidence regarding surgical anatomy of the liver, focusing on useful landmarks, strategies and technical tools to perform precise anatomic liver resection (ALR). METHODS A systematic review was conducted on MEDLINE/PubMed for English articles and on Ichushi database for Japanese articles until September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS A total of 3169 manuscripts were obtained, 1993 in English and 1176 in Japanese literature. Subsequently, 63 English and 20 Japanese articles were selected and reviewed. The quality assessment of comparative series and case series was revealed to be usually low; only six articles were qualified as high quality. Forty-two articles focused on analyzing intersegmental/sectional planes and their relationship with specific hepatic landmark veins. In 12 articles, the authors aimed to investigate liver surface anatomic structures, while 36 articles aimed to study technological tools and contrast agents for surgical segmentation during ALR. Although Couinaud's classification has remained the cornerstone in daily diagnostic/surgical practices, it does not always portray the realistic liver segmentation and there has been no standardization on which a single strategy should be followed to perform precise ALR. CONCLUSIONS A global consensus should be pursued in order to establish clear guidelines and proper recommendations to perform ALR in the era of minimally invasive surgery.
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Affiliation(s)
- Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Andrea Benedetti Cacciaguerra
- Department of Surgery, Hepato-Pancreato-Biliary, Minimally Invasive and Robotic Unit, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, 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, Villejuif, France
| | - Satoshi Ogiso
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - 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
| | - Etsuro Hatano
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Yoshihiro Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
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The evolution of surgery for colorectal liver metastases: A persistent challenge to improve survival. Surgery 2021; 170:1732-1740. [PMID: 34304889 DOI: 10.1016/j.surg.2021.06.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Only a few decades ago, the opinion that colorectal liver metastases were a palliative diagnosis changed. In fact, previously, the prevailing view was strongly resistant against resecting colorectal liver metastases. Constant technical improvement of liver surgery and, much later, effective chemotherapy allowed for a successful wider application of surgery. The clinical use of portal vein embolization was the starting signal of regenerative liver surgery, where insufficient liver volume can be expanded to an extent where safe resection is possible. Today, a number of these techniques including portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy, and bi-embolization (portal and hepatic vein) can be successfully used to address an insufficient future liver remnant in staged resections. It turned out that the road to success is embedding surgery in a well-orchestrated oncological concept of controlling systemic disease. This concept was the prerequisite that meant liver transplantation could enter the treatment strategy for colorectal liver metastases, ending up with a 5-year overall survival of 80% in highly selected cases. In particular, techniques combining principles of 2-stage hepatectomy and liver transplantation, such as "resection and partial liver segment 2-3 transplantation with delayed total hepatectomy" (RAPID) are on the rise. These techniques enable the use of partial liver grafts with primarily insufficient liver volume. All this progress also prompted a number of innovative local therapies to address recurrences ultimately transferring colorectal liver metastases from instantly deadly into a chronic disease in some cases.
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Bonnel F, Duparc F. Historical anatomy of hepatic segmentation: about 250 livers corrosions by Rapp (1953) and Couinaud (1953) in the Conservatory of Anatomy in Montpellier. Surg Radiol Anat 2020; 42:1407-1420. [PMID: 33070211 DOI: 10.1007/s00276-020-02596-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
Two "surgeons-anatomists" Rapp in Montpellier and Couinaud in Paris at the same period (1953) given precise anatomy useful for the hepatic surgery and to the tremendous upheavals of radiological investigations. Actually, the fundamental anatomy of liver is classic with 8 segments with autonomous territories having a vascular afferent pedicle and a venous and biliary efferent drainage. These autonomous territories supported the surgical approach of the liver with the possibility of resecting a hepatic territory in a carcinological perspective well saving quite vascularized parenchyma. It will be in the future history about liver morphology to specify the contribution of these two "surgeons-anatomists". Actually it will be possible to look in the "Conservatory of Anatomy" in Montpellier these original livers corrosions.
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Affiliation(s)
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen Normandy University, 22 Boulevard Gambetta, 76183, Rouen, France.
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Kokudo N, Takemura N, Ito K, Mihara F. The history of liver surgery: Achievements over the past 50 years. Ann Gastroenterol Surg 2020; 4:109-117. [PMID: 32258975 PMCID: PMC7105847 DOI: 10.1002/ags3.12322] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022] Open
Abstract
We reviewed the progress made in the field of liver surgery over the past 50 years. The widespread use and improved outcomes of the hepatectomy were, primarily, due to pioneer surgeons who were responsible for technological advances and rapid improvements in the safety of the procedure in the last century. These advances included the hepatic functional evaluation used to determine the safety limit of liver resections, the introduction of intraoperative ultrasonography, and the development of innovative techniques such as portal vein embolization to increase the remnant liver volume. Cadaveric liver transplantation has been attempted since 1963. However, the clinical outcomes only began improving and becoming acceptable in the 1970s-1980s due to refinements in technology and the development of new immunosuppressants. Partial liver transplantation from living donors, which was first attempted in 1988, required further technological innovation and sophisticated perioperative management plans. Moreover, these developments allowed for further overall improvements to take place in the field of liver surgery. Since the turn of the century, advances in computation and imaging technology have made it possible for safer and more elaborate surgeries to be performed. In Japan, preoperative 3-dimensional simulation technology has been covered by health insurance since 2012 and is now widely used. An urgent need for real-time navigation tools will develop in the future. Indocyanine green (ICG) fluorescence imaging was first used in 2007 and has led to the creation of a new surgical concept known as fluorescence navigation surgery. Laparoscopic surgery and robotic surgery have solved the issue of large incisions, which used to be a major drawback of open liver surgery; however, further improvements are required in order to achieve the level of safety and accuracy observed during open liver resection when performing all minimally invasive procedures. In the near future, liver surgery will become more precise and less invasive due to substantial progress including the development of navigation surgery, cancer imaging, and minimally invasive surgery. This overview of the history of liver surgery over the past 50 years may provide useful insights for further innovation in the next 50 years.
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Affiliation(s)
- Norihiro Kokudo
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Nobuyuki Takemura
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Kyoji Ito
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
| | - Fuminori Mihara
- Department of SurgeryNational Center for Global Health and MedicineTokyoJapan
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Kariyama K, Nouso K, Wakuta A, Oonishi A, Toyoda H, Tada T, Hiraoka A, Tsuji K, Itobayashi E, Ishikawa T, Takaguchi K, Tsutsui A, Shimada N, Kumada T. Treatment of Intermediate-Stage Hepatocellular Carcinoma in Japan: Position of Curative Therapies. Liver Cancer 2020; 9:41-49. [PMID: 32071908 PMCID: PMC7024876 DOI: 10.1159/000502479] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transcatheter arterial chemoembolization (TACE) is the standard therapy for intermediate-stage (IM) hepatocellular carcinoma (HCC). However, IM-HCC includes various clinical conditions, and various therapies were conducted in practice. In this study, we retrospectively analyzed the actually conducted treatments for IM-HCC and their efficacies to elucidate the treatment strategies suitable for IM-HCC. METHODS This study included 627 IM-HCC of 5,260 HCC from 9 hospitals. We examined the treatment strategies of these patients and analyzed the efficacy of each therapy with the Cox proportional hazard model and propensity score-matched analysis. RESULTS Liver resection, radiofrequency ablation (RFA), and TACE were performed in 165, 108, and 351 patients, respectively. Liver resection and RFA were preferably selected in cases of Barcelona Clinic Liver Cancer (BCLC)-B1/B2, and patient survival was significantly longer than in those treated with TACE (p< 0.0001). However, no beneficial effect of these active therapies was observed in cases of BCLC-B3/B4. Multivariate analysis revealed that surgical resection (hazard ratio = 0.384) and RFA (hazard ratio = 0.597) were negative risk factors for survival. Propensity score-matching analysis revealed that -survival of RFA-treated patients was longer than that of TACE-treated patients (p = 0.036). CONCLUSION RFA and surgical resection were effective for IM-HCC, particularly in BCLC-B1/B2 cases.
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Affiliation(s)
- Kazuya Kariyama
- aDepartment of Gastroenterology and Liver Disease Center, Okayama City Hospital, Okayama, Japan
| | - Kazuhiro Nouso
- aDepartment of Gastroenterology and Liver Disease Center, Okayama City Hospital, Okayama, Japan
| | - Akiko Wakuta
- aDepartment of Gastroenterology and Liver Disease Center, Okayama City Hospital, Okayama, Japan
| | - Ayano Oonishi
- aDepartment of Gastroenterology and Liver Disease Center, Okayama City Hospital, Okayama, Japan
| | - Hidenori Toyoda
- bDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Toshifumi Tada
- bDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Atsushi Hiraoka
- cGastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Kunihiko Tsuji
- dCenter of Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Ei Itobayashi
- eDepartment of Gastroenterology, Asahi General Hospital, Chiba, Japan
| | - Toru Ishikawa
- fDepartment of Gastroenterology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Koichi Takaguchi
- gDepartment of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Akemi Tsutsui
- gDepartment of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Noritomo Shimada
- hDepartment of Gastroenterology and Hepatology, Otakanomori Hospital, Chiba, Japan
| | - Takashi Kumada
- bDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan
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Mangieri CW, Strode MA, Bandera BC. Improved hemostasis with major hepatic resection in the current surgical era. Hepatobiliary Pancreat Dis Int 2019; 18:439-445. [PMID: 31307940 DOI: 10.1016/j.hbpd.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 07/02/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Major hepatic resection, predominantly performed for oncologic intent, is a complex procedure with the potential for severe intraoperative hemorrhage. The current surgical era has the ability to improve hemostasis throughout the performance of major hepatic resections which decreases blood transfusions and the detrimental effects associated with transfusion. We evaluated hemostasis and outcomes in the current surgical era of performing hepatic resections. METHODS Utilizing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database all major hepatic resections performed between 2012 and 2016 were analyzed in regards to hemostasis. Hemostasis was evaluated by the need for and magnitude of blood transfusions. Additional perioperative variables (including operative time, length of hospital stay, and mortality rates) were analyzed to assess for outcomes with hemostasis. The NSQIP results were compared to previous publications involving major hepatic resections to detect improvement in hemostasis and outcomes in the current surgical era. RESULTS A total of 22777 major hepatic resections met the inclusion criteria for analysis in the NSQIP database. An additional 21198 cases were compiled within the selected publications for comparative analysis. The transfusion rate in the current surgical era was 13.3% versus 38.7% in the previous era (P = 0.0001). When a transfusion was required in the current surgical era there was a two-fold reduction in the number of units transfused (1.5 U vs. 3.8 U, P = 0.0001). Statistically significant improvements in operative time and length of hospital stay were presented within the current surgical era (P = 0.0001). When a transfusion was required there was an increased relative risk score of 7 for mortality (4.9% vs. 0.7%, P = 0.0001), however, improvement in mortality rates did not reach statistical significance across surgical eras (1.3% vs. 4.0%, P = 0.0001). CONCLUSIONS The conduction of major hepatic resection in the current surgical era is more hemostatic. Correlated with improved hemostasis are better outcomes for both clinical and financial endpoints. These findings should encourage continued and increased performance of major hepatic resections.
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Affiliation(s)
- Christopher W Mangieri
- Department of Surgery, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA 30809, USA.
| | - Matthew A Strode
- Department of Surgery, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA 30809, USA; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA
| | - Bradley C Bandera
- Department of Surgery, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA 30809, USA
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Nanashima A, Ariizumi SI, Yamamoto M. Right anatomical hepatectomy: pioneers, evolution, and the future. Surg Today 2019; 50:97-105. [DOI: 10.1007/s00595-019-01809-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
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10
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Ruso Martinez L. Caprio and Merola: Latin American Contribution to the Development of Liver Surgery. Dig Surg 2018; 36:124-128. [PMID: 29495012 DOI: 10.1159/000487309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 01/30/2018] [Indexed: 12/10/2022]
Abstract
Regarding the history of liver surgery, Latin American pioneers have only occasionally been mentioned in the Anglo-Saxon literature. One of such rare cases was Uruguayan surgeon Gerardo Caprio, who in 1931 published a report about a resection of the left lobe of the liver. This was done during an uneventful period in the development of ideas on this surgical technique, following the remarkable advances made in the last quarter of the 19th Century. The anatomic and liver manipulation concepts used by Caprio had been developed by Merola in reports dating back to 1916 and 1920, which revealed well-grounded disagreements with the most renowned anatomists of the time. This paper discusses Merola and Caprio's academic profile by analyzing their publications, the knowledge base and experience that led the latter to perform such liver resection, and the surgical principles applied to it, which would only be formally adopted worldwide 20 years later.
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Affiliation(s)
- Luis Ruso Martinez
- Professor of Surgery, Chair Department of Surgery, Hospital Maciel (Asse), School of Medicine, University of Repúblic (UdeLar), Montevideo,
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Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience. J Transplant 2016; 2016:7895956. [PMID: 27057348 PMCID: PMC4736995 DOI: 10.1155/2016/7895956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/03/2015] [Indexed: 12/21/2022] Open
Abstract
Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ2-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp(B) = 10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp(B) = 3.645), bilateral tumor spreading (exp(B) = 14.505), tumor grading beyond G2 (exp(B) = 8.668), and vascular infiltration of small or large vessels (exp(B) = 11.612, exp(B) = 18.324, resp.). Grading beyond G2 (exp(B) = 10.498) as well as small and large vascular infiltrations (exp(B) = 13.337, exp(B) = 16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp(B) = 4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ2p = 0.006) and intrahepatic tumor spreading (χ2p = 0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process.
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13
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von Schönfels W, von Kampen O, Patsenker E, Stickel F, Schniewind B, Hinz S, Ahrens M, Balschun K, Egberts JH, Richter K, Landrock A, Sipos B, Will O, Huebbe P, Schreiber S, Nothnagel M, Röcken C, Rimbach G, Becker T, Hampe J, Schafmayer C. Metabolic signature of electrosurgical liver dissection. PLoS One 2013; 8:e72022. [PMID: 24058442 PMCID: PMC3772850 DOI: 10.1371/journal.pone.0072022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS High frequency electrosurgery has a key role in the broadening application of liver surgery. Its molecular signature, i.e. the metabolites evolving from electrocauterization which may inhibit hepatic wound healing, have not been systematically studied. METHODS Human liver samples were thus obtained during surgery before and after electrosurgical dissection and subjected to a two-stage metabolomic screening experiment (discovery sample: N = 18, replication sample: N = 20) using gas chromatography/mass spectrometry. RESULTS In a set of 208 chemically defined metabolites, electrosurgical dissection lead to a distinct metabolic signature resulting in a separation in the first two dimensions of a principal components analysis. Six metabolites including glycolic acid, azelaic acid, 2-n-pentylfuran, dihydroactinidiolide, 2-butenal and n-pentanal were consistently increased after electrosurgery meeting the discovery (p<2.0 × 10(-4)) and the replication thresholds (p<3.5 × 10(-3)). Azelaic acid, a lipid peroxidation product from the fragmentation of abundant sn-2 linoleoyl residues, was most abundant and increased 8.1-fold after electrosurgical liver dissection (preplication = 1.6 × 10(-4)). The corresponding phospholipid hexadecyl azelaoyl glycerophosphocholine inhibited wound healing and tissue remodelling in scratch- and proliferation assays of hepatic stellate cells and cholangiocytes, and caused apoptosis dose-dependently in vitro, which may explain in part the tissue damage due to electrosurgery. CONCLUSION Hepatic electrosurgery generates a metabolic signature with characteristic lipid peroxidation products. Among these, azelaic acid shows a dose-dependent toxicity in liver cells and inhibits wound healing. These observations potentially pave the way for pharmacological intervention prior liver surgery to modify the metabolic response and prevent postoperative complications.
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Affiliation(s)
- Witigo von Schönfels
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
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NIM811 prevents mitochondrial dysfunction, attenuates liver injury, and stimulates liver regeneration after massive hepatectomy. Transplantation 2011; 91:406-12. [PMID: 21131897 DOI: 10.1097/tp.0b013e318204bdb2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Massive hepatectomy (MHX) leads to failure of remnant livers. Excessive metabolic burden in remnant livers may cause mitochondrial dysfunction. This study investigated whether blockade of the mitochondrial permeability transition (MPT) with N-methyl-4-isoleucine cyclosporine (NIM811) improves the outcome of MHX. METHODS Mice were gavaged with NIM811 (10 mg/kg before surgery and 5 mg/kg daily afterward) and underwent sham-operation or approximately 90% partial hepatectomy. RESULTS Serum alanine aminotransferase, necrosis, and apoptosis increased, respectively, to approximately 1200 U/L, 6.1%, and 7% after MHX. NIM811 decreased peak alanine aminotransferase release, necrosis, and apoptosis by 70%, 100%, and 42%, respectively. 5-Bromo-2'-deoxyuridine incorporation, proliferating cell nuclear antigen expression, and the remnant liver weights were all increased significantly by NIM811 treatment, indicating improved liver regeneration. NIM811 also blunted hyperbilirubinemia by 54%, increased serum albumin by 51%, and improved survival from 6% to 40% after MHX. Hepatic mitochondrial depolarization, cell death, and MPT were detected by intravital confocal/multiphoton microscopy of rhodamine 123, propidium iodide, and calcein. Mitochondrial depolarization occurred in many viable hepatocytes (13 cells/high-power field), and nonviable hepatocytes increased slightly to approximately 1 cell/high-power field at 3 hr after MHX. Entry of calcein into mitochondria after MHX indicated MPT onset. Importantly, NIM811 decreased mitochondria depolarization by more than 60%, blocked MPT onset, and prevented cell death. Decreases of hepatic ATP, mitochondrial cytochrome c release, and caspase-3 activation after MHX were also partially blocked by NIM811. CONCLUSIONS NIM811 minimized liver injury and improved liver regeneration after MHX, at least in part, by preventing MPT onset and subsequent compromised energy supply and proapoptotic cytochrome c release.
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Jawad N, Woolf AK, Chin-Aleong JA, Greaves R, Kocher HM. Biliary Cystadenoma Causing Obstructive Jaundice: Case Report and Literature Review. Case Rep Gastroenterol 2009; 3:269-274. [PMID: 21103240 PMCID: PMC2988916 DOI: 10.1159/000226254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Biliary cystadenomas are rare, potentially malignant neoplasms of biliary origin. Presentation is usually with vague and non-specific symptoms. Here, we describe an unusual case of biliary cystadenoma in a woman presenting with acute onset obstructive jaundice and review the relevant literature of 26 such cases reported over the last two decades.
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Affiliation(s)
- Noor Jawad
- Department of Gastroenterology, Whipp's Cross University Hospital, London, UK
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16
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Surgery or ablation for hepatocellular carcinoma. Ann Surg 2009; 249:350. [PMID: 19212196 DOI: 10.1097/sla.0b013e3181982f1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sarmiento JM, Dodson TF. Julian K Quattlebaum, MD: American pioneer of hepatic surgery. J Am Coll Surg 2008; 207:607-611, 611.e1-5. [PMID: 18926467 DOI: 10.1016/j.jamcollsurg.2008.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 12/11/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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Standing on the shoulders of giants. Eur J Surg Oncol 2008; 34:253-5. [DOI: 10.1016/j.ejso.2007.07.207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 07/20/2007] [Indexed: 11/21/2022] Open
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20
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History of Surgery of the Gastrointestinal Tract. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Abstract
Metastatic colorectal cancer to the liver is associated with a uniform poor prognosis without treatment. Advances in therapy over the past decades have now allowed surgical resections of the liver to occur with a low morbidity and mortality. Improvements in chemotherapy regimes have paralleled technical improvements and now allow a new group of patients to become eligible for surgical resection. This chapter will review the recent advances in surgical and chemotherapeutic regimes in metastatic colorectal cancer to the liver.
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Affiliation(s)
- Charlotte-E Ariyan
- Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, Tompkins 202, 333 Cedar Street, New Haven, CT 06520, USA
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22
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Abstract
This article evaluates the available evidence for the efficacy of combined liver and lung metastasectomy. In addition, selection criteria identifying patients most likely to benefit from this approach are discussed. Surgery offers the only possibility for prolonged survival and is occasionally curative.
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Affiliation(s)
- Itzhak Avital
- Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Abstract
While major liver resections have become increasingly safe due to better understanding of anatomy and refinement of operative techniques, liver failure following partial hepatectomy still occurs from time to time and remains incompletely understood. Observationally, certain high-risk circumstances exist, namely, massive resection with small liver remnants, preexisting liver disease, and advancing age, where liver failure is more likely to happen. Upon review of available clinical and experimental studies, an interplay of factors such as impaired regeneration, oxidative stress, preferential triggering of apoptotic pathways, decreased oxygen availability, heightened energy-dependent metabolic demands, and energy-consuming inflammatory stimuli work to produce failing hepatocellular functions.
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Affiliation(s)
- Thomas S Helling
- Department of Surgery, University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA.
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SYMMERS WSC, WARD-McQUAID JN. Successful resection of a large cavernous lymphangiomatoid lesion of the liver of a child aged 19 months. Br J Surg 2005; 38:12-7. [PMID: 15434311 DOI: 10.1002/bjs.18003814904] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Helling TS, Blondeau B. Anatomic segmental resection compared to major hepatectomy in the treatment of liver neoplasms. HPB (Oxford) 2005; 7:222-5. [PMID: 18333194 PMCID: PMC2023956 DOI: 10.1080/13651820510028828] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Familiarity with liver anatomy and refinements in operative technique have led to interest in liver conservation when dealing with hepatic tumors. There is thought to be less morbidity, less blood loss (EBL), a shorter hospital stay (LOS), and no penalty for long-term survival with segmental hepatectomy. METHODS One hundred ninety-six patients who underwent segmental (SEG group) (N=70) or major (MAJOR group) (N=126) hepatectomy for liver neoplasms were retrospectively reviewed. Clinical parameters of mortality, morbidity, EBL, LOS, and actuarial survival in patients with colorectal metastases were examined. RESULTS There were no differences in age or gender between the SEG and MAJOR groups. There were no deaths among 64 non-cirrhotic patients in the SEG group and 4 deaths (3.2%) among 124 non-cirrhotic patients in the MAJOR group (p=0.19). There were 4 postoperative complications in the SEG group (5.6%) and 22 in the MAJOR group (17.3%) (p<0.05).The EBL for the SEG group was 912+/-842 ml compared to 3675+/-3110 ml in the MAJOR group (p<0.001).The hospital LOS for the SEG group was 9.4+/-6.4 days and for the MAJOR group 10.2+/-5.9 days (p=0.32). Life table analysis of survival for resection of colorectal metastases showed two-year patient survival of 40% in the SEG group (N=17) and 45% for the MAJOR group (N=46). CONCLUSION Segmental resections were associated with less EBL and fewer postoperative complications. There was a trend towards fewer deaths in non-cirrhotic patients, and no apparent penalty for a smaller hepatic resection in long-term survival. While sometimes technically more challenging, segmental resections are preferable when feasible and should be utilized in efforts to conserve liver parenchyma.
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Affiliation(s)
- Thomas S. Helling
- Department of Surgery, University of Missouri-Kansas City, School of MedicineKansas City MissouriUSA
| | - Benoit Blondeau
- Department of Surgery, University of Missouri-Kansas City, School of MedicineKansas City MissouriUSA
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Helling TS, Blondeau B, Wittek BJ. Perioperative factors and outcome associated with massive blood loss during major liver resections. HPB (Oxford) 2004; 6:181-5. [PMID: 18333073 PMCID: PMC2020678 DOI: 10.1080/13651820410030826] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mortality and morbidity rates from major liver resections have decreased sharply over the past 25 years. This improvement is due to a better understanding of liver anatomy and the introduction of new operative techniques, but also to improved anesthetic perioperative support. Certain cases are still associated with voluminous blood loss. These patients may be at higher risk for postoperative problems and increased length of stay (LOS) in hospital. METHODS We have retrospectively reviewed 115 patients undergoing major hepatic resections (three or more anatomic segments) with respect to operative blood loss (EBL). Those with an EBL >or=5000 ml (group 1; n = 39) were compared to those with an EBL or=70 years), tumor size, mortality, morbidity, and hospital LOS were examined. Operative reports were examined for any explanation for excessive blood loss. Anesthetic support often entailed the use of a rapid infusion system. RESULTS The EBL was 7692+/-3848 ml for group 1 and 1359+/-514 ml for group 2. Primary liver tumors were resected in 20 patients in group 1 and in 18 patients in group 2. The remaining resections were for metastatic tumors, primarily colorectal in origin. In group 1, 13/39 patients had a left hepatectomy compared to 10/42 patients in group 2 (p=0.34). The overall mortality was 5/1 15. Four deaths occurred in group 1 and one in group 2 (p=0.16). Two deaths in group 1 were intra-operative (hemorrhage, air embolism). There was no difference in the number of patients with complications, 12/ 39 in group 1 and 8/42 in group 2 (p=0.22). Two patients in group 1 required re-operation for bleeding; there were none in group 2. Largest tumor size did not differ between the two groups (p=0.08), nor did the proportion of patients aged 70 years or older (p=0.06). There was no difference in hospital LOS (10.54+/-6.1 vs 8.90+/-4.7 days, p=0.2l). Review of operative notes in group 1 indicated no unusual problems in 13/39, large tumors or proximity to the inferior vena cava in 10/39, and bleeding from the middle hepatic vein in 7/39. Three patients in group 1 required total vascular exclusion for tumor removal; there were none in group 2. DISCUSSION Massive EBL during major liver resection seems to be provoked by tumors near the inferior vena cava or major hepatic veins, or injury to the middle hepatic vein during operation, and not by patient age, tumor size alone, or type of hepatectomy. However, by avoiding prolonged hypotension and hypothermia with the use of rapid infusion devices, the perioperative course of these patients does not differ from those with much less EBL.
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Affiliation(s)
- T S Helling
- Department of Surgery, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA.
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Gertsch P. A historical perspective on colorectal liver metastases and peritoneal carcinomatosis:. Surg Oncol Clin N Am 2003; 12:531-41. [PMID: 14567016 DOI: 10.1016/s1055-3207(03)00046-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Similarities between peritoneal carcinomatosis and liver secondaries allow the oncologist to regard the peritoneum as an intraabdominal structure that can, like the liver, be resected with curative intent when disseminated disease has occurred. The possibility for cure of peritoneal carcinomatosis by cytoreductive surgery and IPHC must now be recognized. However, convincing data from controlled studies will be required for rapid general acceptance of this treatment, bringing, as a consequence, a chance of cure to a larger number of patients with a desperate prognosis. This fact, together with a scarcity of patients with peritoneal carcinomatosis eligible for definitive treatment, emphasizes the need for cooperative studies between centers of reference.
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Affiliation(s)
- Philippe Gertsch
- Department of Surgery, Ospedale San Giovanni, Bellinzona, Switzerland.
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30
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Parks RW, Garden OJ. Liver resection for cancer. World J Gastroenterol 2001; 7:766-71. [PMID: 11854897 PMCID: PMC4695590 DOI: 10.3748/wjg.v7.i6.766] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2001] [Revised: 06/10/2001] [Accepted: 06/15/2001] [Indexed: 02/06/2023] Open
Affiliation(s)
- R W Parks
- Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary of Edinburgh, UK.
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31
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Fortner JG, Blumgart LH. A historic perspective of liver surgery for tumors at the end of the millennium. J Am Coll Surg 2001; 193:210-22. [PMID: 11491452 DOI: 10.1016/s1072-7515(01)00910-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- J G Fortner
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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SILEN W, MAWDSLEY D, JENSEN P, GARDNER RE. Hepatic lobectomy in the treatment of tumors of the liver in children. Ann Surg 1998; 150:1065-70. [PMID: 14446654 PMCID: PMC1629001 DOI: 10.1097/00000658-195912000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Affiliation(s)
- S I Schwartz
- Department of Surgery at the University of Rochester Medical Center in Rochester, New York 14642, USA
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41
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42
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van Leeuwen MS, Obertop H, Hennipman AH, Fernandez MA. 3-D reconstruction of hepatic neoplasms: a preoperative planning procedure. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1995; 9:121-33. [PMID: 7772810 DOI: 10.1016/0950-3528(95)90073-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Three-dimensional display of intrahepatic vascular structures, tumour(s) and liver surface offers the possibility of perceiving the complex individual anatomy in a coherent fashion. Since this presentation of anatomical structures can be varied at will, the resulting interactive dynamic display of the 3-D data sets can be considered an example of Virtual Reality; the surgeon experiences the interactive 3-D display as a realistic presentation of the patient's surgical anatomy. Three-dimensional display offers the possibility of planning a specific resection in detail, tailored to the individual anatomy. The benefits and problems of various surgical approaches can be worked out in detail, and potential hazardous phases in the operation can be anticipated, thus minimizing unexpected complications. However, because the generation of detailed 3-D renderings takes considerable time investment by an experienced operator it is important to select patients, in whom such an effort is warranted. In our experience, 3-D display of the liver is most likely to be of benefit in the presence of central tumours, or if segmental resections are considered.
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Affiliation(s)
- M S van Leeuwen
- Department of Radiodiagnostic Radiology, University Hospital Utrecht, The Netherlands
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43
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Hodgson WJ. Parenchymal dissection techniques. Cancer Treat Res 1994; 69:221-30. [PMID: 8031653 DOI: 10.1007/978-1-4615-2604-9_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- W J Hodgson
- New York Medical College, Westchester Medical Center, Munger Pavilion, Valhalla 10595
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44
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Abstract
The incidence of colorectal cancer in the United States is increasing. Because more than half of patients with colorectal cancer have liver metastases develop, the number of patients with hepatic metastases also is increasing. Unfortunately, metastatic disease will be limited to the liver in perhaps 25% of these patients and confined to only one lobe of the liver 25% of this subgroup. Consequently, solitary or unilobar colorectal metastases are found in as few as 5% of patients with colorectal cancer. The median survival of patients with unresected hepatic metastases is approximately 10.6 months. Patients with solitary lesions or small tumor burdens may attain a median survival of 16-20 months, but 5-year survivors are extremely rare. In contrast, rates of 5-year survival average approximately 36% after resections of solitary hepatic lesions and may approach the same level in selected patients with multiple lesions. Factors that appear to adversely effect survival include detection of metastatic disease because of signs or symptoms of disease, an elevated carcinoembryonic antigen (CEA) level, elevated liver function tests, poorly differentiated primary lesions, lymph node-positive primary lesions, extrahepatic sites of metastases, more than four hepatic lesions, bilobar disease, a satellite pattern of metastases in the liver, positive margins of the liver resection, positive extrahepatic lymph nodes, and more than 10 units of blood transfusion during the perioperative period. Operative mortality for liver resections should remain approximately 4%, and major morbidity should be in the range of 20-30%. Modalities other than surgical resection have not improved survival in patients with colorectal hepatic metastases. Thus, when feasible, patients with metastatic colorectal cancer limited to one lobe of the liver should undergo hepatic resection. Unfortunately, only approximately 5% of patients with colorectal cancer fall into this category, so resection of hepatic metastases can improve overall survival of patients with colorectal cancer by only 1-2%.
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Affiliation(s)
- G H Ballantyne
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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45
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Abstract
Resection of hepatic metastases of colorectal origin has gained wide acceptance, but when patients have synchronous or metachronous pulmonary metastases, they are often considered incurable and are offered systemic therapy only. We performed a retrospective review of the patients at Memorial Sloan-Kettering Cancer Center who underwent resection of both hepatic and pulmonary metastases of colorectal origin between 1970 and 1990. Ten patients were identified who met the above criteria. Median survival after hepatic and pulmonary resections were 34 and 18 months, respectively. Actuarial 1-, 3- and 5-year survivals are 89%, 78% and 52%, respectively. With a median of 18 months after second operation, three patients have no evidence of disease (NED), four are alive with disease (AWD) and three are dead of disease (DOD). In the absence of effective chemotherapy, selected patients with hepatic and pulmonary metastases of colorectal origin should be considered for resection as it offers the only possibility for long-term survival.
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Affiliation(s)
- J W Smith
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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46
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Hodgson WJ, Morgan J, Byrne D, DelGuercio LR. Hepatic resections for primary and metastatic tumors using the ultrasonic surgical dissector. Am J Surg 1992; 163:246-50. [PMID: 1739181 DOI: 10.1016/0002-9610(92)90110-d] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have previously described the development of new hepatic surgical techniques using the ultrasonic surgical dissector. With 10 years' experience, we have found that major liver resections have been simplified and that the technique is repeatable in hands other than our own. Thirty-three patients had 37 tumors, averaging 5.65 cm in size, resected with an average blood loss of only 1,020 mL per case, which included 5 right trisegmentectomies, 12 lobectomies, 15 segmental resections, and 4 subsegmental resections. Twenty-two patients had metastatic colorectal cancer. Blood transfusion requirements averaged only 2.24 units in long-term survivors, which was significantly less than the 3.5 units received by patients who have since died (p = 0.092). There were no operative deaths. The median survival of these 22 patients was 56 months, and the 5-year actuarial survival rate was 35%. All of the early deaths occurred in patients with more than four tumors, and no patient with less than four tumors died before 42 months with recurrent disease. Six patients had bilateral tumors, and the fact that patients survived into the fourth and fifth post-resectional year indicates that resection was worthwhile. All these patients had Dukes' C primary tumors, but we found no statistical difference in survival between patients with Dukes' B and Dukes' C lesions. The results indicate that hepatic resection with the ultrasonic surgical dissector decreases blood loss, requires few transfusions, is safe to perform, and is associated with excellent long-term survival.
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Affiliation(s)
- W J Hodgson
- Department of Surgery, New York Medical College, Westchester County Medical Center, Valhalla 10595
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Abstract
The current performance and applicability of elective hepatic resection represents an impressive evolution. From removal of tumor-bearing, ill-defined portions of the liver, which is always threatened by the inability to control bleeding, surgery of the liver has progressed to hemostatically controlled dissection of anatomically defined portions of the organ. Accompanying the series of technical refinements that have markedly reduced the mortality and morbidity rates associated with the procedure, there has been an expansion of the indications for hepatic resection.
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Affiliation(s)
- S Iwatsuki
- Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania
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49
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Abstract
Thirty-four hepatic resections were performed on 33 patients. These included 4 trisegmentectomies, 14 lobectomies, 7 segmentectomies, and 9 wedge resections. Twenty patients had metastatic colorectal cancer, 4 had a primary liver tumor, 2 had giant cavernous hemangioma, 1 had metastatic leiomyosarcoma, 5 had various benign lesions including focal nodular hyperplasia, and 1 patient had resection for trauma. Operative morbidity included four subphrenic abscesses, one bile leak, one bile duct injury, one case of cholestasis, and one case of phlebitis. There were no operative deaths. The median survival of the patients with metastatic colorectal cancer was 40 months, and the 5-year actuarial survival rate was 35 percent. Survival rates were not significantly different between patients with a solitary metastasis and those with multiple lesions and was not influenced by size of the metastases. However, survival was significantly better in patients whose primary colorectal lesion was Dukes' B as compared with those whose lesion was Dukes' C. The results indicate that liver resection can be performed safely with acceptable morbidity and improved long-term survival.
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Affiliation(s)
- F F Attiyeh
- Department of Surgery, St. Luke's/Roosevelt Hospital, New York, New York
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50
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Abstract
Over a 24-year period, 411 partial hepatic resections were performed: 142 right or left trisegmentectomies, 158 lobectomies, 25 segmentectomies, and 86 local excisions. The operations were performed for benign lesions in 182 patients, for primary hepatic malignancies in 106, and for hepatic metastases in 123, including 90 from colorectal cancers. The 30-day (operative) mortality rate was 3.2%, and there were an additional six late deaths (1.5%) due to hepatic failure caused by the resection. The highest operative mortality rate (6.3%) resulted from the trisegmentectomies, but this merely reflected the extent of the disease being treated. A mortality rate of 8.5% for patients with primary hepatic malignancy was associated not only with the extensiveness of lesions, but also with cirrhosis in the remaining liver fragment. There was no mortality for 123 patients with metastatic disease, 100 patients with cavernous hemangioma, 22 with liver cell adenoma, 17 with focal nodular hyperplasia, 16 with congenital cystic disease, and five with hydatid cysts. Trauma, pre-existing iatrogenic injury, and cirrhosis were the only conditions that had lethal portent in patients with benign disease. Furthermore, patients with benign disease who survived operation had minimal liability from recurrence of their original disease and none from the resection per se. By contrast, tumor recurrence dominated the actuarial survival rates for cancer patients, which at 1 and 5 years were 68.5% and 31.9%, respectively, after resection for primary hepatic malignancy, and 84.2% and 29.5%, respectively, for hepatic metastases. In this report, the expanding role of partial hepatectomy in the treatment of liver disease was emphasized, as well as the need for considering, in some cases, the alternative of total hepatectomy and liver replacement.
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Affiliation(s)
- S Iwatsuki
- Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, Pennsylvania
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