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Luo Y, Yin Q, Chen K, Deng Z, Liu X, Zhou Y, Zhu B, Zhang W, Ma Z. Superselective embolic particle guidance in vessel networks via shape-adaptive acoustic manipulation. Nat Commun 2025; 16:254. [PMID: 39747085 PMCID: PMC11696135 DOI: 10.1038/s41467-024-55478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 12/12/2024] [Indexed: 01/04/2025] Open
Abstract
Interventional embolization has been widely used as a clinical cancer therapy, which deactivates the tumors by occluding their blood supply vessels. However, conventional methods lack active control over the embolic particles, thus having a limited selectivity of millimeter-scale vessels and the issue of missing embolization. Here, we propose an ultrasound-based method for embolic particle control in submillimeter vessels. The biocompatible ultrasound generated from an extrasomatic source can transmit through biological tissues, and exert forces on the intravital embolic particles. We show that the particles, influenced by these forces, are steerable to the target branch at vascular bifurcations. By modulating the ultrasound to adapt the vascular bifurcation distribution, the particles flowing in the micro-vessel networks are steered to the target branch and embolize it. The acoustic steering within ex vivo and in vivo models both verify the potential of this non-invasive particle control for precise and safe interventional therapy.
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Affiliation(s)
- Yucheng Luo
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiu Yin
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Keke Chen
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoyu Deng
- Key Laboratory of Modern Acoustics, Collaborative Innovation Center of Advanced Microstructures, Institute of Acoustics and School of Physics, Nanjing University, Nanjing, China
| | - Xiaozhou Liu
- Key Laboratory of Modern Acoustics, Collaborative Innovation Center of Advanced Microstructures, Institute of Acoustics and School of Physics, Nanjing University, Nanjing, China
| | - Yinning Zhou
- Joint Key Laboratory of the Ministry of Education, Institute of Applied Physics and Materials Engineering, University of Macau, Macau, China
| | - Benpeng Zhu
- School of Integrated Circuit, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Wenming Zhang
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China.
| | - Zhichao Ma
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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2
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Gao F, Xie Q, Ran X, Zhao X, Yang M, Jiang K, Mao T, Yang J, Li K, Wu H. Use of indocyanine green-human serum albumin complexes in fluorescence image-guided laparoscopic anatomical liver resection: a case series study (with video). Surg Endosc 2024; 38:6938-6947. [PMID: 39342539 PMCID: PMC11525420 DOI: 10.1007/s00464-024-11295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND This study aimed to investigate the feasibility and efficacy of near-infrared fluorescence-guided laparoscopic anatomical hepatectomy (LAH) using a novel indocyanine green (ICG)-human serum albumin complex (HSA) in patients with hepatocellular carcinoma. METHODS Clinical data of hepatocellular carcinoma patients who underwent ICG-HSA fluorescence-guided LAH at our center from January 2024 to April 2024 were prospectively collected and analyzed. Ultraviolet absorption spectroscopy was used to test the absorption and stability of ICG-HSA complex solutions under different conditions. After determining the optimal ratio, the complex was administered intravenously during surgery to perform negative staining via Glissonean pedicle isolation. LAH was performed along the fluorescence-demarcated boundaries. RESULTS Thirty-one patients were included (24 men; mean age, 54.61 ± 13.54 years). The median maximum tumor diameter was 2.80 (interquartile range [IQR], 2.00-4.00) cm. S8 segmentectomy (22.6%) and right posterior segmentectomy (19.4%) were the most common resections performed. Successful fluorescence negative staining was achieved in all patients using ICG and HSA at a 1:6 molar ratio at room temperature. Mean operation time was 297.58 ± 85.53 min, Median intraoperative blood loss was 100.0 mL (IQR, 50.0-200.0). The median surgical margin distance was 0.90 cm (IQR, 0.40-1.50). The postoperative complication rate was 45.2% (35.5% Clavien-Dindo grade I and 9.7% grade II). The median length of hospital stay was 5.0 days (IQR, 4.0-5.0). CONCLUSION ICG-HSA-assisted LAH is safe and feasible. Compared with free ICG, the novel ICG-HSA complex exhibits better optical properties and in vivo stability, which can improve the accuracy of intraoperative liver segment localization and optimize the anatomical dissection plane. It has the potential to become an ideal fluorescent imaging agent for anatomical hepatectomy.
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Affiliation(s)
- Fengwei Gao
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qingyun Xie
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xiaoyun Ran
- Key Laboratory of Green Chemistry and Technology of Ministry of Education, College of Chemistry, Sichuan University, Chengdu, 61064, Sichuan, China
| | - Xin Zhao
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Manyu Yang
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Kangyi Jiang
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Tianyang Mao
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Jiayin Yang
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Kun Li
- Key Laboratory of Green Chemistry and Technology of Ministry of Education, College of Chemistry, Sichuan University, Chengdu, 61064, Sichuan, China
| | - Hong Wu
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
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Sekiguchi N, Takahashi H, Akita H, Yamada D, Tomimaru Y, Noda T, Mukai Y, Hasegawa S, Kobayashi S, Doki Y, Eguchi H, Wada H. Long-term impact of replaced right hepatic artery resection in pancreaticoduodenectomy. Updates Surg 2024; 76:1257-1263. [PMID: 38526700 DOI: 10.1007/s13304-024-01811-9] [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: 11/20/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
The clinical impact of replaced right hepatic artery (rRHA) resection during pancreaticoduodenectomy (PD) has not been thoroughly investigated. We therefore assessed the short- and long-term effects of rRHA resection during PD, with special reference to alterations in the volumetric profile of the liver. Patients with rRHA were divided into two groups based on the presence (R group) or absence (nR group) of resection. The nR group included cases of rRHA resection and reconstruction. We compared the postoperative short-term complications and detailed liver volume profile by CT volumetry in the long term between the R and nR groups. Forty-seven patients were eligible for the analyses of short-term outcomes (R: n = 7, nR: n = 40), and no marked difference was observed in the incidence of short-term postoperative complications. The patient cohort for the long-term investigations included 34 cases (R: n = 6, nR: n = 28), excluding patients with early recurrence. There was no significant difference in the preoperative liver volume profiles between the two groups. At 12 postoperative months, although the whole liver (WL) volume did not significantly change in either group, the ratio of the volume of the anterior/posterior sections significantly increased in the R group (R: pre- vs. 12 months, 1.01 vs. 1.28, p < 0.05; nR: pre- vs. 12 months, 1.40 vs. 1.33, p = 0.99). Long-term rRHA resection did not significantly affect the WL volume with alteration of the liver volumetric profile of each section.
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Affiliation(s)
- Naoko Sekiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan.
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan.
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Yosuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Shinichiro Hasegawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 E2, Suita-Shi, Osaka, 565-0871, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-Ku, Osaka-Shi, Osaka, 541-8567, Japan
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Zaarour Y, Derbel H, Tran C, Saccentia L, Longère B, Blain M, Amaddeo G, Luciani A, Kobeiter H, Tacher V. Evaluation of a new beads reflux control microcatheter in drug-eluting bead transarterial chemoembolization. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 10:100048. [PMID: 39077730 PMCID: PMC11265494 DOI: 10.1016/j.redii.2024.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/01/2024] [Indexed: 07/31/2024]
Abstract
Rationale and objectives A new microcatheter was recently developed claiming to reduce beads reflux in drug-eluting bead transarterial chemoembolization (DEB-TACE). The aim of this study was to compare the reflux control microcatheter ability versus a standard microcatheter for TACE treatment in patients with hepatocellular carcinoma. Material and methods Patients were prospectively included between November 2017 and February 2022. They received a DEB-TACE treatment with charged radiopaque beads using standard microcatheters or the SeQure reflux control microcatheter (Guerbet, France) and were assigned respectively to a control and a test group. Beads distribution mismatch was evaluated between the targeted territory on treatment planning CBCT and beads' spontaneous opacities on the post-intervention CBCT and the 1-month CT scanner. Results Twenty-three patients (21 men, median age 64 years [12.5 years]) with 37 hepatocellular carcinoma nodules were treated. The control group consisted of 13 patients - 19 nodules, while the test group included ten patients - 18 nodules. Non target embolization (NTE) was found in 20 % (2/10) of patients in the test group and 85 % (11/13) in the control group. NTE involved only an adjacent segment in the test group while it affected the adjacent biliary sector or even the contralateral liver lobe in the control group. No complication linked to NTE was found in the test group, while it led to one case of ischemic cholangitis and another case of biloma in the control group. Conclusion The reflux control microcatheter may be efficient in reducing NTE and thus eventual adverse events in comparison to standard of care end-hole microcatheters.
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Affiliation(s)
- Youssef Zaarour
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - Haytham Derbel
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - Charles Tran
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Laetitia Saccentia
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Benjamin Longère
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Department of Cardiovascular Radiology, Institut Cœur-Poumon, CHU de Lille, 59037 Lille, France
| | - Maxime Blain
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Giuliana Amaddeo
- Department of Hepatology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 94010 Créteil, France
| | - Alain Luciani
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
- Unité Inserm U955, équipe n°18, IMRB, 94010 Créteil, France
| | - Hicham Kobeiter
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Vania Tacher
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
- Unité Inserm U955, équipe n°18, IMRB, 94010 Créteil, France
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Miyayama S. Radiological Vascular Anatomy of the Caudate Lobe of the Liver Required for Transarterial Chemoembolization of Hepatocellular Carcinoma. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:118-129. [PMID: 38020459 PMCID: PMC10681755 DOI: 10.22575/interventionalradiology.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
The caudate lobe is located between the bilateral hepatic lobes and is divided into three subsegments: the Spiegel lobe, paracaval portion, and caudate process. The caudate artery arises from various sites of the bilateral hepatic arteries as an independent branch, common trunk, or arcade. Extrahepatic arteries can enter the caudate lobe mainly by the right inferior phrenic artery. The caudate artery also supplies the main bile duct and posterior aspect of segment IV. Although catheterization into the caudate artery is occasionally difficult because of its small size and sharp angulation, selective embolization of a tumor feeder is a significant prognostic factor in patients with hepatocellular carcinoma originating there. Therefore, we should recognize the peculiarity of its vascular anatomy and should be familiar with catheterization and embolization techniques.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Japan
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Taiji R, Lin YM, Chintalapani G, Lin EY, Huang SY, Mahvash A, Avritscher R, Liu CA, Lee RC, Resende V, Nishiofuku H, Tanaka T, Kichikawa K, Klotz E, Gupta S, Odisio BC. A novel method for predicting hepatocellular carcinoma response to chemoembolization using an intraprocedural CT hepatic arteriography-based enhancement mapping: a proof-of-concept analysis. Eur Radiol Exp 2023; 7:4. [PMID: 36717474 PMCID: PMC9886747 DOI: 10.1186/s41747-022-00315-8] [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: 05/12/2022] [Accepted: 12/01/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of a novel approach for predicting hepatocellular carcinoma (HCC) response to drug-eluting beads transarterial chemoembolization (DEB-TACE) using computed tomography hepatic arteriography enhancement mapping (CTHA-EM) method. METHODS This three-institution retrospective study included 29 patients with 46 HCCs treated with DEB-TACE between 2017 and 2020. Pre- and posttreatment CTHA-EM images were generated using a prototype deformable registration and subtraction software. Relative tumor enhancement (TPost/pre-RE) defined as the ratio of tumor enhancement to normal liver tissue was calculated to categorize tumor response as residual (TPost-RE > 1) versus non-residual (TPost-RE ≤ 1) enhancement, which was blinded compared to the response assessment on first follow-up imaging using modified RECIST criteria. Additionally, for tumors with residual enhancement, CTHA-EM was evaluated to identify its potential feeding arteries. RESULTS CTHA-EM showed residual enhancement in 18/46 (39.1%) and non-residual enhancement in 28/46 (60.9%) HCCs, with significant differences on TPost-RE (3.05 ± 2.4 versus 0.48 ± 0.23, respectively; p < 0.001). The first follow-up imaging showed non-complete response (partial response or stable disease) in 19/46 (41.3%) and complete response in 27/46 (58.7%) HCCs. CTHA-EM had a response prediction sensitivity of 94.7% (95% CI, 74.0-99.9) and specificity of 100% (95% CI, 87.2-100). Feeding arteries to the residual enhancement areas were demonstrated in all 18 HCCs (20 arteries where DEB-TACE was delivered, 2 newly developed collaterals following DEB-TACE). CONCLUSION CTHA-EM method was highly accurate in predicting initial HCC response to DEB-TACE and identifying feeding arteries to the areas of residual arterial enhancement.
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Affiliation(s)
- Ryosuke Taiji
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA ,grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Yuan-Mao Lin
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Gouthami Chintalapani
- Siemens Medical Solutions USA Inc, 501 North Barrington Road, Hoffman Estates, IL 60192 USA
| | - Ethan Y. Lin
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Steven Y. Huang
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Armeen Mahvash
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Rony Avritscher
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Chien-An Liu
- grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Rheun-Chuan Lee
- grid.278247.c0000 0004 0604 5314Department of Radiology, Taipei Veterans General Hospital, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Vivian Resende
- grid.8430.f0000 0001 2181 4888Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Hideyuki Nishiofuku
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Toshihiro Tanaka
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Kimihiko Kichikawa
- grid.410814.80000 0004 0372 782XDepartment of Radiology and Nuclear Medicine, Nara Medical University, Kashihara, Nara, 634-8521 Japan
| | - Ernst Klotz
- grid.481749.70000 0004 0552 4145Siemens Healthineers, Siemensstraße 3, 91301 Forchheim, Germany
| | - Sanjay Gupta
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Bruno C. Odisio
- grid.240145.60000 0001 2291 4776Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
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Yamamoto R, Sugiura T, Ashida R, Ohgi K, Yamada M, Otsuka S, Aramaki T, Asakura K, Uesaka K. Vascular resection for distal cholangiocarcinoma. Surg Today 2022:10.1007/s00595-022-02634-0. [PMID: 36550287 DOI: 10.1007/s00595-022-02634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Vascular resection (VR) is extended surgery to attain a negative radial margin (RM) for distal cholangiocarcinoma (DCC). The present study explored the significance of VR for DCC, focusing on VR, RM, and findings suggestive of vascular invasion on multidetector-row computed tomography (MDCT). METHODS Patients with DCC who underwent resection between 2002 and 2019 were reviewed. RESULTS Among 230 patients, 25 received VR. The overall survival (OS) in the VR group was significantly worse than in the non-VR group (16.7% vs. 50.7% at 5 years, P < 0.001). Patients who underwent VR with a negative RM failed to show a better OS than those who did not undergo VR with a positive RM (19.7% vs. 35.7% at 5 years, P = 0.178). Of the 30 patients who were suspected of having vascular invasion on MDCT, 11 did not receive VR because the vessels were freed from the tumor; these patients had a significantly better OS (57.9% at 5 years) than those who underwent VR. CONCLUSIONS VR for DCC was associated with a poor prognosis, even if a negative RM was obtained. VR is not necessary for DCC when the vessels are detachable from the tumor.
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Affiliation(s)
- Ryusei Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
| | - Takeshi Aramaki
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Koiku Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan
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Yamamoto H, Sambommatsu Y, Ishii M, Shimata K, Isono K, Honda M, Sugawara Y, Inomata Y, Hibi T. Surgical Outcomes of Domino Liver Transplantation Using Grafts From Living Donors With Familial Amyloid Polyneuropathy. Liver Transpl 2022; 28:603-614. [PMID: 34989109 DOI: 10.1002/lt.26401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 01/13/2023]
Abstract
Domino liver transplantation (DLT) using grafts from donors with familial amyloid polyneuropathy is an acceptable procedure for expanding the donor pool. The vascular and biliary reconstructions in living donor DLT (LDDLT) are technically demanding, and data on the short-term and long-term surgical outcomes of domino donors and recipients in LDDLT are limited. In this study, we identified 25 domino recipients from our liver transplantation program (1999-2018), analyzed the vascular and biliary reconstructions performed, and evaluated the surgical outcomes, including graft survival. Piggyback technique was adopted in all 25 domino donors. The only surgical complication in domino donors was hepatic vein (HV) stenosis with an incidence rate of 4%. In 22 domino recipients, right HV and middle/left HV were reconstructed separately. A total of 10 recipients had 2 arteries anastomosed, and 18 underwent duct-to-duct biliary anastomosis. HV stenosis and biliary stricture had incidence rates of 8% and 24%, respectively, in the recipients, but none of them developed hepatic artery thrombosis. The 1-year and 5-year graft survival rates were 100% each in the domino donors, and 84.0% and 67.3% in the domino recipients, respectively. In conclusion, LDDLT has acceptable outcomes without increasing the operative risk in donors despite the demanding surgical technique involved.
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Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masatsugu Ishii
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | | | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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9
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Takeuchi S, Ambo Y, Kodama Y, Takada M, Kato K, Nakamura F, Hirano S. Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series. Surg Case Rep 2022; 8:49. [PMID: 35316851 PMCID: PMC8941043 DOI: 10.1186/s40792-022-01403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported cases. Here, we reported five cases, wherein preoperative embolization of rRHA was performed for combined resection. Case presentation All patients had pancreatic head malignancies that were in contact with rRHA. We performed a preoperative embolization of the rRHA before the scheduled pancreaticoduodenectomy for the combined resection. Arterial embolization was safely accomplished, and the communicating arcade from the left hepatic artery via the hilar plate was clearly revealed in all cases. Four patients underwent the operative procedure, except for one patient who had liver metastasis at laparotomy. No patient suffered from a severe abnormal liver function during the management; however, one patient had multiple liver infarctions during the postoperative course. Conclusions Preoperative embolization for the combined resection of rRHA in pancreaticoduodenectomy can be a management option for the precise evaluation of hemodynamics after sacrificing rRHA. In our cases, arterial flow to the right liver lobe was supplied by the left hepatic artery via the bypass route, including the communicating arcade of the hilar plate.
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Affiliation(s)
- Shintaro Takeuchi
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yoshihisa Kodama
- Department of Radiology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kentaro Kato
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Fumitaka Nakamura
- Department of Surgery, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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10
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Yamamoto H, Matsuoka R, Tsuyuki Y, Kamimura K, Tsukamoto K, Tachibana M, Aoyama T, Kanamori N, Tsutsumi Y. Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection. Intern Med 2022; 61:53-58. [PMID: 34176844 PMCID: PMC8810253 DOI: 10.2169/internalmedicine.7793-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of spontaneous isolated dissection of the celiac artery. A Japanese man in his 50s visited an emergency unit, complaining of sudden epigastralgia. Contrast-enhanced computed tomography indicated dissection of the celiac artery with patent false and true lumina, extending to the splenic and common hepatic arteries. On day 3 of hospitalization, the dissection progressed to the proper and right hepatic arteries. Progression of the dissection to the right hepatic artery provoked acalculous ischemic cholecystitis, and cholecystectomy followed. The resected gallbladder revealed extensive aseptic necrosis with little inflammatory reaction, and the gallbladder neck was spared from ischemia.
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Affiliation(s)
| | - Ryota Matsuoka
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | | | | | - Kei Tsukamoto
- Department of Diagnostic Radiology, Shimada Municipal Hospital, Japan
| | | | - Takeshi Aoyama
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Norio Kanamori
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Yutaka Tsutsumi
- Department of Diagnostic Pathology, Shimada Municipal Hospital, Japan
- Diagnostic Pathology Clinic, Pathos Tsutsumi, Japan
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11
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Aramburu J, Antón R, Fukamizu J, Nozawa D, Takahashi M, Ozaki K, Ramos JC, Sangro B, Bilbao JI, Tomita K, Matsumoto T, Hasebe T. In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization. BIOLOGY 2021; 10:biology10121341. [PMID: 34943256 PMCID: PMC8698760 DOI: 10.3390/biology10121341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.
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Affiliation(s)
- Jorge Aramburu
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- Correspondence:
| | - Raúl Antón
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
| | - Junichi Fukamizu
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Daiki Nozawa
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Makoto Takahashi
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Kouji Ozaki
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Juan Carlos Ramos
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Liver Unit and CIBEREHD, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Department of Radiology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
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12
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Egorov VI, Petrov RV, Amosova EL, Kharazov AF, Petrov KS, Zhurina YA, Kondratyev EV, Zelter PM, Dzigasov SO, Grigorievsky MV. [Distal pancreatectomy with resection of the celiac trunk, right or left hepatic artery without arterial reconstruction (extended DP-CAR)]. Khirurgiia (Mosk) 2021:13-28. [PMID: 34608776 DOI: 10.17116/hirurgia202110113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate safety and postoperative outcomes of DP-CAR with resection of one of the lobar hepatic arteries without arterial reconstruction (extended DP-CAR). MATERIAL AND METHODS Perioperative data and survival after 7 extended DP-CARs R0 were retrospectively analyzed. Arterial blood flow in the liver was assessed using intraoperative ultrasound and postoperative CT angiography. RESULTS Among 40 DP-CARs, resection of left or right hepatic artery was performed in 7 cases of aberrant anatomy including 1 case of portal vein resection. Mortality and ischemic complications were not observed. The main source of blood supply to the «devascularized» liver lobe was interlobar communicating artery or the arcade of the lesser curvature of the stomach. Incidence of pancreatic fistula was 44%, mean blood loss - 230 (100-650) ml, surgery time - 259 (195-310) min, mean hospital-stay - 14 (9-26) days. Median survival of patients with pancreatic ductal adenocarcinoma was 25 months after combined treatment. Three patients died after 26, 28 and 77 months. Other patients are alive without progression for 109, 24, 23 and 12 months after therapy onset. CONCLUSION Extended DP-CAR is advisable and safe procedure if reliable intraoperative control of liver and stomach blood supply is ensured.
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Affiliation(s)
- V I Egorov
- Ilyinskaya Hospital, Krasnogorsk, Russia
| | - R V Petrov
- Ilyinskaya Hospital, Krasnogorsk, Russia
| | | | - A F Kharazov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | | | | | - E V Kondratyev
- Ilyinskaya Hospital, Krasnogorsk, Russia.,Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - P M Zelter
- Samara State Medical University, Samara, Russia
| | | | - M V Grigorievsky
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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13
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Lin YM, Lin EY, Tseng HS, Lee RC, Huang HE, Wang SE, Shyr YM, Liu CA. Preventive covered stent placement at the gastroduodenal artery stump in angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. Abdom Radiol (NY) 2021; 46:4995-5006. [PMID: 34037809 DOI: 10.1007/s00261-021-03123-7] [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: 02/22/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of preventive covered stent placement at the gastroduodenal artery stump in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy. METHODS Between July 2006 and September 2018, patients undergoing computed tomography angiography or diagnostic angiography for sentinel hemorrhage after pancreaticoduodenectomy were retrospectively reviewed. Patients having angiogram-negative angiography and undergoing preventive covered stent placement or conservative treatment were included. Clinical outcomes, technique success, and complications were evaluated. RESULTS A total of 25 patients (mean age 62.5 years) were evaluated, including 15 patients underwent preventive covered stent placement at the gastroduodenal artery stump and 10 patients received conservative treatments. The clinical success rates were 50% (5/10) and 86.7% (13/15) for conservative treatments and covered stent groups, respectively (p = 0.07). In the conservative treatment group, delayed massive hemorrhage occurred in five patients, two of whom died of recurrent bleeding due to gastroduodenal artery pseudoaneurysm within 16 days, and two had intraluminal hemorrhage within 5 days. In the covered stent group, one patient had inferior pancreaticoduodenal artery pseudoaneurysm 1 day after the placement of the covered stent, and one had recurrent bleeding due to duodenal ulcer within 14 days. The 30-day mortality was 40% (4/10) and 0 in the conservative treatment and covered stent groups, respectively (p = 0.02). The difference in the overall survival was nonsignificant between the two groups (p = 0.23). CONCLUSIONS The preventive covered stent placement at the gastroduodenal artery stump is safe and reduces delayed massive hemorrhage and short-term mortality in patients with angiogram-negative sentinel hemorrhage after pancreaticoduodenectomy.
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14
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Burasakarn P, Higuchi R, Yazawa T, Uemura S, Izumo W, Matsunaga Y, Yamamoto M. Hepatic artery resection without reconstruction in pancreatoduodenectomy. Langenbecks Arch Surg 2021; 406:2081-2090. [PMID: 33932159 DOI: 10.1007/s00423-021-02178-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE It has been reported that there are left and right hepatic arterial arcades via the blood vessels around the hilar bile duct; therefore, when the hilar bile duct is preserved, hepatic artery reconstruction may not be necessary. We compared the short-term and long-term outcomes in patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy (PD) with right hepatic artery resection without right hepatic artery reconstruction (RHAR group) with those patients who underwent conventional PD. METHODS All data were retrospectively collected from patient records. A 1:4-propensity score-matched case-control study was conducted in patients with distal cholangiocarcinoma who received treatment at Tokyo Women's Medical University from February 1985 to April 2015. RESULTS There was no statistical difference in the overall morbidity rate between the two groups. No patient in the RHAR group (10 patients) had liver failure, liver abscess, or cholangitis in the postoperative period; one patient died postoperatively because of a bleeding pseudoaneurysm in the gastroduodenal artery. The PD group (40 patients) had a significantly better median time regarding the recurrence (34 vs. 11 months, p=0.027) and 5-year disease-free survival (35% vs. 10%, p=0.027) rates than the RHAR group, which may be attributed to the presence of a more severe disease in patients in the RHAR group. CONCLUSION We concluded that pancreaticoduodenectomy with right hepatic artery resection without reconstruction has a comparable overall morbidity rate with that of a conventional pancreaticoduodenectomy surgery and may be performed as an alternative procedure when tumor invasion of the right hepatic artery is suspected.
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Affiliation(s)
- Pipit Burasakarn
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Wataru Izumo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yutaro Matsunaga
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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15
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Anatomical Basis for Selective Multiple Arterial Reconstructions in Living Donor Liver Transplantation. Langenbecks Arch Surg 2021; 406:1943-1949. [DOI: 10.1007/s00423-021-02176-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/12/2021] [Indexed: 01/16/2023]
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16
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Kwon J, Shin SH, Yoo D, Hong S, Lee JW, Youn WY, Hwang K, Lee SJ, Park G, Park Y, Lee W, Song KB, Lee JH, Hwang DW, Kim SC. Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion: A single-center experience with 109 patients. Medicine (Baltimore) 2020; 99:e22115. [PMID: 32925757 PMCID: PMC7489745 DOI: 10.1097/md.0000000000022115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 02/12/2020] [Accepted: 03/01/2020] [Indexed: 12/13/2022] Open
Abstract
Pancreatectomy for pancreatic cancer with arterial invasion is controversial and performed infrequently. As its indication evolves and neoadjuvant chemotherapy also evolves, it is meaningful to identify short- and long-term outcomes of pancreatectomy with arterial resection (AR). This study aimed to retrospectively analyze the clinical outcomes of pancreatectomy with AR for pancreatic ductal adenocarcinoma.Patients with pancreatic ductal adenocarcinoma treated with pancreatectomy with AR at our institute between January 2000 and April 2017 were retrospectively reviewed. Operative outcome and survival were compared according to the presence of neoadjuvant chemotherapy.This study included 109 patients (38 underwent surgery after neoadjuvant chemotherapy, 71 underwent upfront surgery). The median hospital stay was 17 (interquartile range, 12-26.5) days. Clinically relevant postoperative pancreatic fistula (grade B or C) occurred in 14 patients (12.8%). The major morbidity (≥grade III) and mortality rates were 26.6% and 0.9%, respectively. R0 resection was achieved in 80 patients (73.4%). Microscopic actual tumor invasion into the arterial wall was identified in 25 patients (22.9%). The median overall survival (OS) of all patients was 18.4 months. The neoadjuvant chemotherapy group showed better OS than the upfront surgery group, without statistical significance (25.3 vs 16.2 months, P = .06). Progression-free survival was better in patients with neoadjuvant chemotherapy (13.2 vs 7.1 months, P = .01). Patients with partial response to neoadjuvant chemotherapy showed better OS than those with stable disease (33.7 vs 17.5 months, P = .04).Pancreatectomy with AR for advanced pancreatic cancer showed acceptable procedure-related morbidity and mortality. A survival benefit of neoadjuvant chemotherapy was identified, compared to upfront surgery.
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Affiliation(s)
- Jaewoo Kwon
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Daegwang Yoo
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Sarang Hong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Jong Woo Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Woo Young Youn
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Kyungyeon Hwang
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Seung Jae Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Guisuk Park
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Yejong Park
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Woohyung Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Ki Byung Song
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Jae Hoon Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Dae Wook Hwang
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
| | - Song Cheol Kim
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center
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Kimura Y, Imamura M, Kuroda Y, Nagayama M, Itoh T, Oota S, Murakami T, Yamaguchi H, Nobuoka T, Kawaharada N, Takemasa I. Clinical usefulness of saphenous vein graft in major arterial reconstruction during extended pancreatectomy. Langenbecks Arch Surg 2020; 405:1051-1059. [DOI: 10.1007/s00423-020-01947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
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18
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Amano T, Mori K, Kikuchi S, Sakai M, Hoshiai S, Enokido M, Koyama K, Minami M. Chemoembolization of a hepatocellular carcinoma supplied by a caudate artery forming a common trunk with the supraduodenal artery: A case report. Radiol Case Rep 2020; 15:891-894. [PMID: 32382375 PMCID: PMC7200616 DOI: 10.1016/j.radcr.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022] Open
Abstract
The supraduodenal artery might arise from the hepatic, gastroduodenal, or right gastric arteries, but only a few studies have addressed the branching pattern of this artery. We herein describe a case of an 80-year-old man with hepatocellular carcinoma located in segment I. Selective arteriography and CT angiography showed that the supraduodenal artery formed a common trunk with the caudate artery to feed the tumor. The patient was successfully treated with superselective transarterial chemoembolization without gastrointestinal complications. To avoid nontargeting chemoembolization of the duodenum, interventional radiologists should be aware of this branching pattern. In suspected cases, selective CT arteriography plays a crucial role.
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Affiliation(s)
- Taishi Amano
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
- Corresponding author.
| | - Kensaku Mori
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Syunsuke Kikuchi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Masafumi Sakai
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Sodai Hoshiai
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Midori Enokido
- Department of Diagnostic and Interventional Radiology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Ibaraki, Japan
| | - Ken Koyama
- Department of Diagnostic and Interventional Radiology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Ibaraki, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
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Kim HC, Miyayama S, Chung JW. Selective Chemoembolization of Caudate Lobe Hepatocellular Carcinoma: Anatomy and Procedural Techniques. Radiographics 2020; 39:289-302. [PMID: 30620696 DOI: 10.1148/rg.2019180110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transarterial chemoembolization is the most common treatment for unresectable hepatocellular carcinomas (HCCs). However, when an HCC is located in the caudate lobe, many interventional radiologists are reluctant to perform chemoembolization and percutaneous ablation owing to the tumor's complex vascular supply and deep location. With the advent of C-arm CT, rendering the three-dimensional display of the hepatic artery and detecting the tumor-feeding vessels are possible and can help guide interventional radiologists to the tumor. The common origins of the caudate artery include the right hepatic artery, left hepatic artery, right anterior hepatic artery, and right posterior hepatic artery. The origins of the tumor-feeding arteries of a caudate lobe HCC can vary depending on the tumor's subsegmental location. Caudate lobe HCCs are commonly fed by multiple caudate arteries that are connected. In addition, extrahepatic collateral arteries frequently supply recurrent tumors in the caudate lobe. The caudate artery can supply portal vein thrombi or biliary tumor thrombi in patients with HCC. Several techniques such as preshaping the microcatheter or using the shepherd's hook technique are needed to catheterize the caudate artery in complex cases. Although uncommon, bile duct stricture is a serious complication following selective chemoembolization through the caudate artery. Identification and catheterization of the caudate artery have become possible in most patients by using C-arm CT and a fine microcatheter system, respectively. The authors review the anatomy of the caudate artery with C-arm CT and describe basic technical considerations in selective chemoembolization for caudate lobe HCCs. Unusual circumstances that require catheterization and techniques used for catheterizing the caudate artery are also described. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Hyo-Cheol Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea (H.C.K., J.W.C.); and Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.)
| | - Shiro Miyayama
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea (H.C.K., J.W.C.); and Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.)
| | - Jin Wook Chung
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea (H.C.K., J.W.C.); and Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.)
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Irie T, Takahashi N, Hoshiai S. Balloon-occluded transarterial chemoembolization for hepatocellular carcinoma: History, background, and the roles. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Toshiyuki Irie
- Department of Radiology, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | | | - Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Balloon-Occluded Trans-Arterial Chemo-Embolization Technique with Repeated Alternate Infusion of Cisplatin Solution and Sparse Gelatin Slurry (RAIB-TACE) for Large Hepatocellular Carcinoma Nodules More than 7 cm in Diameter. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9289321. [PMID: 32051830 PMCID: PMC6995320 DOI: 10.1155/2020/9289321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022]
Abstract
Objective It is sometimes difficult to obtain complete/partial response of large hepatocellular carcinoma (HCC) nodules by trans-arterial chemoembolization/embolization (TACE/TAE). The aim is retrospective investigation of tumor response of large HCC nodules (>7 cm) treated by the new TACE technique, repeated alternate infusion of cisplatin solution, and sparse gelatin slurry under balloon occlusion (RAIB-TACE). Materials and Methods. A microballoon catheter was placed at a proximal portion of the hepatic artery (subsegmental to the lobar level hepatic artery), and alternate infusion of cisplatin solution and sparse gelatin slurry were repeated under balloon occlusion until stasis of gelatin slurry beyond the catheter was seen. RAIB-TACE of multiple proximal hepatic and extrahepatic collateral arteries were performed to treat hemi-lobe or more of the liver while avoiding infusion into gastric and cystic arteries for 19 large nodules (>7 cm) in 19 patients without portal venous invasion. All patients underwent dynamic CT/MRI 1-3 months after RAIB-TACE, and tumor response of each large nodule was evaluated based on modified RECIST criteria. Results CR, PR, SD, and PD were achieved in 11, 8, 0, and 0 nodules, respectively. CR and PR were considered as success, and the ratio of success was 100%. Major complications were abscess formation in the necrotic nodule (n = 1) which was treated by drainage tube placement, and subsegmental level liver infarction (n = 1) which was treated by drainage tube placement, and subsegmental level liver infarction (. Conclusion New TACE technique, RAIB-TACE, was useful to achieve successful response of large HCC nodules.
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Kundaragi NG, Asthana S, Reddy J, Lochan R. Hepatic arterial communicating arcades-Case series and review of literature. Indian J Radiol Imaging 2020; 29:462-467. [PMID: 31949354 PMCID: PMC6958894 DOI: 10.4103/ijri.ijri_413_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/22/2022] Open
Abstract
This case series describes the hepatic arterial communicating arcades and their importance in the endovascular management of hepatic artery pseudoaneurysm, pediatric post liver transplant lobar arterial occlusion, and lobar arterial stenosis due to gall bladder carcinoma. We describe new types of arterial communicating arcades which have not been described earlier.
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Affiliation(s)
- Nischal G Kundaragi
- Department of Interventional Radiology and Interventional Oncology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sonal Asthana
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Jayanth Reddy
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Rajiv Lochan
- Department of Hepatobiliary and Multi-Organ Transplantation Surgery, Aster CMI Hospital, Bengaluru, Karnataka, India
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23
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Ezponda A, Rodríguez-Fraile M, Morales M, Vivas I, De La Torre M, Sangro B, Bilbao JI. Hepatic Flow Redistribution is Feasible in Patients with Hepatic Malignancies Undergoing Same-Day Work-Up Angiography and Yttrium-90 Microsphere Radioembolization. Cardiovasc Intervent Radiol 2019; 43:987-995. [PMID: 31848672 DOI: 10.1007/s00270-019-02371-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/31/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. MATERIALS AND METHODS From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. RESULTS Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. CONCLUSION Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.
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Affiliation(s)
- A Ezponda
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.
| | - M Rodríguez-Fraile
- Department of Nuclear Medicine, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - M Morales
- Department of Nuclear Medicine, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - I Vivas
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - M De La Torre
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.,Clínica Universidad de Navarra, Calle Marquesado de Sta Marta n°1, 28027, Madrid, Spain
| | - B Sangro
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.,Clínica Universidad de Navarra, Calle Marquesado de Sta Marta n°1, 28027, Madrid, Spain
| | - J I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
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Double-Balloon-Assisted N-Butyl-2-Cyanoacrylate Embolization of Nontumorous Intrahepatic Arterioportal Shunts. J Vasc Interv Radiol 2019; 30:1210-1214.e2. [PMID: 31257137 DOI: 10.1016/j.jvir.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022] Open
Abstract
This report describes the safety and efficacy of double-balloon-assisted N-butyl-2-cyanoacrylate embolization of nontumorous intrahepatic arterioportal shunts in 5 consecutive, previously untreated patients. A proximal balloon was used for flow control and a coaxial microballoon was used to control the delivery of N-butyl-2-cyanoacrylate. Complete occlusion was achieved in 3 patients and shunt flow decreased in 2 patients, without complications. In the latter 2 patients, pre-embolization shunt flow was lower than that in patients with complete occlusion. Our results suggest that this coaxial double-balloon-assisted technique may be safe and effective for the embolization of nontumorous intrahepatic arterioportal shunts, especially in high-flow shunts.
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25
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Balloon-Occluded Trans-Arterial Chemoembolization Technique with Alternate Infusion of Cisplatin and Gelatin Slurry for Small Hepatocellular Carcinoma Nodules Adjacent to the Glisson Sheath. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8350926. [PMID: 31211142 PMCID: PMC6532302 DOI: 10.1155/2019/8350926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/13/2019] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
Objective It is difficult to control small hepatocellular carcinoma (HCC) nodules adjacent to the Glisson sheath (GS) by trans-arterial chemoembolization (TACE) probably due to multiple small tumor feeders directly branching from the trunk artery. The purpose of this study was to conduct a retrospective evaluation of a new TACE technique called the repeated alternate infusion of cisplatin solution and gelatin slurry distal to balloon occlusion (RAIB-TACE), for the treatment of small HCC nodules adjacent to GS. Materials and Methods Small nodules less than 4 cm attached to proximal portion of the subsegmental to lobar level portal branch were retrospectively selected. Between January 2011 and April 2014, 29 nodules in 29 patients were treated by super-selective lipiodol TACE/balloon-occluded TACE (B-TACE) (Lip-TACE group). Since April 2014, treatment protocols for small nodules adjacent to GS were changed, and 14 nodules in 12 patients were treated by RAIB-TACE (RAIB-TACE group). In RAIB-TACE group, alternate infusion of cisplatin solution and sparse gelatin slurry (mixture of 80 mg of gelatin fragments and 20 mL of contrast medium) were repeated until arterial flow was ceased. In Lip-TACE group, lipiodol was used as drug carrier and dense gelatin slurry (mixture of 80 mg of gelatin fragments and 2 mL of contrast medium) as embolization material. Dynamic CT/MRI was obtained 1-3 months after TACE, and response of each nodule was evaluated basing on modified RECIST criteria. Results In RAIB-TACE group, all 14 nodules (100%) were diagnosed as CR or PR. In Lip-TACE group, 18 of 29 (62.1%) were diagnosed as CR or PR. There was a statistically significant difference in objective response ratio between the groups (p=0.008, Fisher's test). Biloma (n=1) and benign stricture of the right hepatic duct (n=1) were seen in RAIB-TACE group. The biloma shrunk without treatment and the patient had no symptom, but the patient with biliary stricture repeated cholangitis and was treated by administration of antibiotics. Conclusion The study results show that RAIB-TACE is more effective than lipiodol TACE/B-TACE for small hepatocellular carcinoma adjacent to GS. We speculate that one of the reasons to explain why Lip-TACE is inferior to RAIB-TACE is that viscous lipiodol or dense gelatin slurry could not flow into small tumor feeders effectively.
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Rose SC, Narsinh KH, Isaacson AJ, Fischman AM, Golzarian J. The Beauty and Bane of Pressure-Directed Embolotherapy: Hemodynamic Principles and Preliminary Clinical Evidence. AJR Am J Roentgenol 2019; 212:686-695. [PMID: 30589385 DOI: 10.2214/ajr.18.19975] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
OBJECTIVE Particulate emboli are passive agents that follow blood flow. Deployed antireflux devices obstruct blood flow. CONCLUSION The aim of this review is to describe the complex hemodynamic alterations to blood flow caused by the deployment of antireflux devices and the resulting changes to embolic distribution. The therapeutic goal is optimization of embolization safety and efficacy.
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Affiliation(s)
- Steven C Rose
- 1 Department of Radiology, UCSD Medical Center, 200 W Arbor Dr, MC 8756, San Diego, CA 921023
| | - Kazim H Narsinh
- 2 Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Ari J Isaacson
- 3 Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Aaron M Fischman
- 4 Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Jafar Golzarian
- 5 Department of Radiology, University of Minnesota, Minneapolis, MN
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Hatanaka T, Arai H, Kakizaki S. Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Hepatol 2018; 10:485-495. [PMID: 30079135 PMCID: PMC6068849 DOI: 10.4254/wjh.v10.i7.485] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma (HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) guidelines. Recently, balloon-occluded TACE (B-TACE) was developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion (LE) accumulation in HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials; it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of B-TACE.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Gastroenterology, Saiseikai Maebashi Hospital, Gunma 371-0821, Japan
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Gunma 371-0014, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan.
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Aramburu J, Antón R, Rivas A, Ramos JC, Larraona GS, Sangro B, Bilbao JI. Numerical zero-dimensional hepatic artery hemodynamics model for balloon-occluded transarterial chemoembolization. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2983. [PMID: 29575739 DOI: 10.1002/cnm.2983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
Balloon-occluded transarterial chemoembolization (B-TACE) is a valuable treatment option for patients with inoperable malignant tumors in the liver. Balloon-occluded transarterial chemoembolization consists of the transcatheter infusion of an anticancer drug mixture and embolic agents. Contrary to conventional TACE, B-TACE is performed via an artery-occluding microballoon catheter, which makes the blood flow to redistribute due to the intra- and extrahepatic arterial collateral circulation. Several recent studies have stressed the importance of the redistribution of blood flow in enhancing the treatment outcome. In the present study, the geometries of a representative hepatic artery and the communicating arcades (CAs) are modeled. An in silico zero-dimensional hemodynamic model is created by characterizing the geometry and the boundary conditions and then is validated in vitro. The role of CAs is assessed by combining 2 cancer scenarios and 2 catheter locations. The importance of the diameter of the CAs is also studied. Results show that occluding a main artery leads to collateral circulation and CAs start to play a role in blood-flow redistribution. In summary, numerical zero-dimensional simulations permit a fast and reliable approach for exploring the blood-flow redistribution caused by the occlusion of a main artery, and this approach could be used during B-TACE planning.
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Affiliation(s)
- Jorge Aramburu
- TECNUN Escuela de Ingenieros, Universidad de Navarra, P° Manuel Lardizabal 13, 20018, Donostia-San Sebastián, Spain
| | - Raúl Antón
- TECNUN Escuela de Ingenieros, Universidad de Navarra, P° Manuel Lardizabal 13, 20018, Donostia-San Sebastián, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Av. Pío XII 36, 31008, Pamplona, Spain
| | - Alejandro Rivas
- TECNUN Escuela de Ingenieros, Universidad de Navarra, P° Manuel Lardizabal 13, 20018, Donostia-San Sebastián, Spain
| | - Juan Carlos Ramos
- TECNUN Escuela de Ingenieros, Universidad de Navarra, P° Manuel Lardizabal 13, 20018, Donostia-San Sebastián, Spain
| | - Gorka S Larraona
- TECNUN Escuela de Ingenieros, Universidad de Navarra, P° Manuel Lardizabal 13, 20018, Donostia-San Sebastián, Spain
| | - Bruno Sangro
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Av. Pío XII 36, 31008, Pamplona, Spain
- Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Av. Pío XII 36, 31008, Pamplona, Spain
| | - José Ignacio Bilbao
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Av. Pío XII 36, 31008, Pamplona, Spain
- Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Spain
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Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments. J Clin Med 2018; 7:jcm7050094. [PMID: 29723964 PMCID: PMC5977133 DOI: 10.3390/jcm7050094] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/14/2022] Open
Abstract
Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as bleeding. Readers of this article will come to understand the pathophysiology and anatomy underlying post-PTBD bleeding, its incidence, its varied clinical manifestations and its initial management. Additionally, a structured approach to its treatment emphasizing endovascular and percutaneous methods is given.
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Yoshida K, Matsui O, Miyayama S, Ibukuro K, Yoneda N, Inoue D, Kozaka K, Minami T, Koda W, Gabata T. Isolated Arteries Originating from the Intrahepatic Arteries: Anatomy, Function, and Importance in Intervention. J Vasc Interv Radiol 2018; 29:531-537.e1. [PMID: 29477620 DOI: 10.1016/j.jvir.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023] Open
Abstract
Isolated hepatic arteries are defined as hepatic terminal arterioles that are not accompanied by portal venules or bile ductules and penetrate the liver parenchyma and distribute to the hepatic capsule and intrahepatic hepatic veins. Abundant communications exist between intra- and extrahepatic arteries through isolated arteries and capsular arterial plexus. They play a principal role in the development of subcapsular hemorrhage and arterial collateral formation following transcatheter arterial chemoembolization for liver cancers. The anatomy, function, and clinical importance of isolated hepatic arteries in interventional radiology, especially regarding subcapsular hemorrhage and arterial collateral formation, are highlighted in this article.
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Affiliation(s)
- Kotaro Yoshida
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Osamu Matsui
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui City, Fukui, Japan
| | - Kenji Ibukuro
- Department of Radiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Asano T, Nakamura T, Noji T, Okamura K, Tsuchikawa T, Nakanishi Y, Tanaka K, Murakami S, Ebihara Y, Kurashima Y, Shichinohe T, Hirano S. Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction. Langenbecks Arch Surg 2018; 403:195-202. [PMID: 29362881 DOI: 10.1007/s00423-018-1650-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE It has been reported that preoperative embolization or intraoperative reconstruction of the replaced right hepatic artery (rRHA) in order to secure the arterial blood flow to the liver and biliary tract are useful for patients who have undergone pancreaticoduodenectomy (PD) with concomitant rRHA resection. In this study, the feasibility of concomitant resection of rRHA in PD without preoperative embolization or intraoperative reconstruction were retrospectively evaluated with a particular focus on postoperative complications. METHODS We retrospectively analyzed 323 consecutive patients who underwent PD. RESULTS In 51 patients (15.8%), an rRHA was detected. Nine of 51 patients underwent combined rRHA resection during PD. Eight patients showed tumor abutment, and one patient had accidental intraoperative damage of the rRHA. Although there were no cases of bilioenteric anastomotic failure, a hepatic abscess occurred in one patient. This patient was treated with percutaneous transhepatic abscess drainage and was cured immediately without suffering sepsis. Postoperative complications of Clavien-Dindo classification ≥ IIIa were found in three patients, and R0 resection was achieved in six. Surgical outcomes showed no significant differences between the rRHA-resected and non-resected groups. Moreover, there were no significant differences in laboratory data related to liver functions between the rRHA-resected and non-resected groups before surgery and on postoperative days 1, 3, 5, and 7. CONCLUSIONS Simple resection of the rRHA following an unintended or accidental injury during PD is not associated with severe morbidity and should be considered as an alternative to a technically difficult reconstruction.
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Affiliation(s)
- Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Japan
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Matsumoto T, Tomita K, Suda S, Hashida K, Maegawa S, Hayashi T, Yamagami T, Suzuki T, Hasebe T. Microballoon-related interventions in various endovascular treatments of body trunk lesions. MINIM INVASIV THER 2017; 27:2-10. [PMID: 29113514 DOI: 10.1080/13645706.2017.1398174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Satoshi Suda
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Kazunobu Hashida
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Shunto Maegawa
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Toshihiko Hayashi
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Takuji Yamagami
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
- Department of Radiology, Kochi University, Kochi Medical School, Kochi, Japan
| | - Tetsuya Suzuki
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
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Asayama Y, Okamoto D, Ushijima Y, Nishie A, Ishigami K, Takayama Y, Fujita N, Honda H. Predictors of therapeutic effect of transarterial chemoembolisation using drug-eluting beads for hepatocellular carcinoma. Clin Radiol 2017; 72:780-785. [PMID: 28442142 DOI: 10.1016/j.crad.2017.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/31/2017] [Accepted: 03/27/2017] [Indexed: 01/29/2023]
Abstract
AIMS To identify predictors of a therapeutic effect after transarterial chemoembolisation using drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Between January 2015 and July 2015, tumour variables and angiographic data were collected for 25 patients (49 target lesions) after they had undergone the DEB-TACE procedure for HCC. The therapeutic effect was evaluated according to the Response Evaluation Criteria in Cancer of the Liver at follow-up dynamic computed tomography (CT) performed within 1-4 months after the procedure. A p<0.05 was considered significant. RESULTS On a target lesion basis, the objective response (TE3/4) rate was 63.3% (31 of 49). On univariate analysis, larger size (≥2 cm) was a predictor of an objective response (p=0.029). The tumour location of the medial (segment 4) or caudate (segment 1) lobe also indicated a poor therapeutic effect (TE1/2), but not at the level of significance (p=0.051). Multivariate analysis identified tumour size (odds ratio, 8.60; 95% confidence interval, 1.87-62.8) and tumour location (odds ratio, 12.2; 95% confidence interval, 2.12-129.8) as significant factors associated with a therapeutic effect. On a patient basis, 10 of 25 (40%) patients showed complete response/partial response. There were no significant differences between complete response/partial response and stable disease/progressive disease regarding age, gender, tumour markers, history of previous treatment, Child-Pugh class, T-stage, or Barcelona Clinic Liver Cancer Staging. CONCLUSION A short-term therapeutic effect was associated with tumour size and location on a target lesion basis.
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Affiliation(s)
- Y Asayama
- Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - D Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Y Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - A Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - K Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Y Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - N Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - H Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Ye S, Dong JH, Duan WD, Ji WB, Liang YR. The Preliminary Study on Procurement Biliary Convergence from Donors with Complicated Bile Duct Variant in Emergency Right Lobe Living Donor Liver Transplantation. J Clin Exp Hepatol 2017; 7:33-41. [PMID: 28348469 PMCID: PMC5357717 DOI: 10.1016/j.jceh.2016.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/28/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of biliary complications after living donor adult liver transplantation (LDALT) is still high due to the bile duct variation and necessity reconstruction of multiple small bile ducts. The current surgical management of the biliary variants is unsatisfactory. We evaluated the role of a new surgical approach in a complicated hilar bile duct variant (Nakamura type IV and Nakamura type II) under emergent right lobe LDALT for high model for end-stage liver disease score patients. METHODS The common hepatic duct (CHD) and the left hepatic duct (LHD) of the donor were transected in a right-graft including short common trunks with right posterior and anterior bile ducts, whereas the LHD of the donor was anastomosed to the CHD and the common trunks of a right-graft bile duct and the recipient CHD was end-to-end anastomosed. RESULTS Ten of 13 grafts (Nakamura types II, III, and IV) had two or more biliary orifices after right graft lobectomy; seven patients had biliary complications (53.8%). Later, the surgical innovation was carried out in five donors with variant bile duct (four Nakamura type IV and one type II), and, consequently, no biliary or other complications were observed in donors and recipients during 47-53 months of follow-up; significant differences (P < 0.05) were found when two stages were compared. CONCLUSION Our initial experience suggests that, in the urgent condition of LDALT when an alternative live donor was unavailable, a surgical innovation of cutting part of the CHD trunks including variant right hepatic ducts in a complicated donor bile duct variant may facilitate biliary reconstruction and reduce long-term biliary complications.
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Key Words
- CHD, common hepatic duct
- CUSA, cavitron ultrasonic surgical aspirator
- CVP, central venous pressure
- HTK, histidine-tryptophan-ketoglutarate
- LDALT, living donor adult liver transplantation
- LDLT
- LHD, left hepatic duct
- MELD, model for end-stage liver disease
- MHA, middle hepatic artery
- MHV, middle hepatic vein
- MRCP, magnetic resonance cholangiopancreatography
- PHA, proper hepatic artery
- RHA, right hepatic artery
- RHD, right hepatic duct
- RHV, right hepatic vein
- RPV, right portal vein
- bile duct variant
- biliary complications
- surgical innovation
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Affiliation(s)
- Sheng Ye
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, 168 Litang Road, Dongxiaokou Town, Changping District, Beijing 102218, China,Address for correspondence: Sheng Ye, Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, 168 Litang Road, Dongxiaokou Town, Changping District, Beijing 102218, China. Fax: +86 10 56118500.Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University168 Litang Road, Dongxiaokou Town, Changping DistrictBeijing102218China
| | - Jia-Hong Dong
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, 168 Litang Road, Dongxiaokou Town, Changping District, Beijing 102218, China
| | - Wei-Dong Duan
- Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxin Road, Beijing 100853, China
| | - Wen-Bing Ji
- Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxin Road, Beijing 100853, China
| | - Yu-Rong Liang
- Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxin Road, Beijing 100853, China
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Sugihara F, Murata S, Ueda T, Yasui D, Yamaguchi H, Miki I, Kawamoto C, Uchida E, Kumita SI. Haemodynamic changes in hepatocellular carcinoma and liver parenchyma under balloon occlusion of the hepatic artery. Eur Radiol 2016; 27:2474-2481. [PMID: 27678134 DOI: 10.1007/s00330-016-4573-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/05/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. METHODS Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. RESULTS In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. CONCLUSIONS Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. KEY POINTS • Hepatic artery occlusion causes haemodynamic changes in hepatocellular carcinoma and liver. • Segmental occlusion decreased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Subsegmental occlusion increased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Hepatic artery occlusion decreased enhancement volume of hepatocellular carcinoma and liver. • Hepatic artery occlusion causes perfusion defects in hepatocellular carcinoma.
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Affiliation(s)
- Fumie Sugihara
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Satoru Murata
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan.
| | - Tatsuo Ueda
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Daisuke Yasui
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Hidenori Yamaguchi
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Izumi Miki
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
| | - Chiaki Kawamoto
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Eiji Uchida
- Department of Surgery, Nippon Medical School, Tokyo, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
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Noji T, Tsuchikawa T, Okamura K, Tanaka K, Nakanishi Y, Asano T, Nakamura T, Shichinohe T, Hirano S. Concomitant hepatic artery resection for advanced perihilar cholangiocarcinoma: a case-control study with propensity score matching. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:442-448. [DOI: 10.1002/jhbp.363] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Takehiro Noji
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II; Hokkaido University Graduate School of Medicine; Kita 15 Nishi 7, Kita-ku Sapporo Hokkaido 060-8638 Japan
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Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: Risk Factors Associated with Mortality and Complications. J Vasc Interv Radiol 2016; 28:50-59.e5. [PMID: 27321887 DOI: 10.1016/j.jvir.2016.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate risk factors predicting death and complications of primary therapy for hepatic and gastric duodenal artery pseudoaneurysms following endovascular treatment (EVT) after pancreaticoduodenectomy (PD). MATERIALS AND METHODS Between April 2004 and December 2014, 28 patients (mean age, 64.7 y) with post-PD hemorrhage underwent EVT. Prevention of hepatic artery blockage via stents or side-holed catheter grafts was stratified in cases without a replaced hepatic artery. Mortality and major hepatic complications following EVT were evaluated according to age; sex; surgery-EVT interval; presence of portal vein stenosis, shock, and coagulopathy at EVT onset; and post-EVT angiographic findings. RESULTS All hemorrhages were successfully treated with microcoils (n = 17; 61%), covered stents (n = 1; 3%), bare stent-assisted coil embolization (n = 5; 18%), or catheter grafts with coil embolization (n = 5; 18%). Hepatic arterial flow was observed after EVT in 18 patients (64%). Mortality and major hepatic complication rates were 28.6% and 32.1%, respectively. Hemorrhagic shock and coagulopathy at EVT onset (n = 8 each; odds ratio [OR], 27; 95% confidence interval [CI], 3.1-235.7; P < .01) were significantly associated with mortality. Coagulopathy at EVT onset (adjusted OR [aOR], 48.1; 95% CI, 3.2-2,931), portal vein stenosis (n = 16; aOR, 16.9; 95% CI, 1.3-721.9), and no visualization of hepatopetal flow through the hepatic arteries (n = 10; aOR, 29.5; 95% CI, 2.1-1,477) were significantly associated with major hepatic complications. CONCLUSIONS EVT should be performed as soon as possible before the development of shock or coagulopathy. Hepatic arterial flow visualization decreases major hepatic complications.
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Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report. Int J Surg Case Rep 2016; 25:66-70. [PMID: 27327560 PMCID: PMC4917395 DOI: 10.1016/j.ijscr.2016.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/07/2016] [Accepted: 05/13/2016] [Indexed: 01/07/2023] Open
Abstract
The aberrant right hepatic artery is often arising from superior mesenteric artery. Combined resection of the aberrant right hepatic artery is necessary in pancreaticoduodenectomy for pancreatic head cancer to achieve R0 resection. Arterial anastomosis of combined resection is not always necessary because of existence of communicating artery from the middle and left hepatic artery via hepatic hilar plate. R0 resection without tumor exposure at the dissected plane improves prognosis of pancreatic cancer patients. Introduction This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. Presentation of case A 63-year-old woman was admitted to our institute’s Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient’s postoperative course was uneventful. Discussion In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. Conclusion By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.
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Double-Balloon-Assisted n-Butyl-2-Cyanoacrylate Embolization of Intrahepatic Arterioportal Shunt Prior to Chemoembolization of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2016; 39:1479-83. [DOI: 10.1007/s00270-016-1377-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video). Clin J Gastroenterol 2016; 9:86-8. [PMID: 26960930 DOI: 10.1007/s12328-016-0637-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/02/2016] [Indexed: 12/12/2022]
Abstract
A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs.
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Kakuta A, Shibutani K, Ono S, Miura H, Tsushima F, Kakehata S, Basaki K, Fujita H, Seino H, Fujita T, Takai Y. Temporal variations in stump pressure and assessment of images obtained from cone-beam computed tomography during balloon-occluded transarterial chemoembolization. Hepatol Res 2016; 46:468-76. [PMID: 26333025 DOI: 10.1111/hepr.12579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/29/2015] [Accepted: 08/20/2015] [Indexed: 12/20/2022]
Abstract
AIM Balloon-occluded transcatheter arterial chemoembolization (B-TACE) was used to show the optimized duration of balloon occlusion to start injection of lipiodol in order to maximize lipiodol deposition in the nodule, and to reveal the endpoint of lipiodol injection. METHODS Of 29 consecutive patients who underwent balloon-occluded TACE between November 2013 and February 2014, we were able to measure stump pressure for 219 nodules in 27 patients. Tumors were counted, measured and could be visually assessed in 20 of these patients at 26 sites. Tumors with multiple feeders were found in eight patients. Arterial blood pressure was measured before, immediately after and 5 min after balloon occlusion prior to intra-arterial injection, as well as before and after balloon deflation after intra-arterial injection. Images were assessed qualitatively by two radiologists as well as quantitatively by calculating the contrast-to-noise ratio. RESULTS We found no significant difference in pressure between immediately after and 5 min after balloon occlusion. Mean stump pressure before balloon deflation after intra-arterial injection was 70.4 mmHg. We observed a significant increase in qualitative scores after balloon occlusion (P < 0.001), and the mean score in the third-order branch was significantly higher than that in the first-order branch (P = 0.048). CONCLUSION Our results indicate that intra-arterial injection can be started at any time after balloon occlusion and that 70 mmHg may be considered as a possible indicator of the end-point for arterial injection.
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Affiliation(s)
- Akihisa Kakuta
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Koichi Shibutani
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Shuichi Ono
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Hiroyuki Miura
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Fumiyasu Tsushima
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Shinya Kakehata
- Department of Radiology, Aomori Prefectural Central Hospital, Hirosaki, Japan
| | - Kiyoshi Basaki
- Department of Radiology, Aomori Prefectural Central Hospital, Hirosaki, Japan
| | - Hiromasa Fujita
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Hiroko Seino
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Tamaki Fujita
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine
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Asayama Y, Nishie A, Ishigami K, Ushijima Y, Takayama Y, Okamoto D, Fujita N, Morita K, Honda H. Hemodynamic changes under balloon occlusion of hepatic artery: predictor of the short-term therapeutic effect of balloon-occluded transcatheter arterial chemolipiodolization using miriplatin for hepatocellular carcinoma. SPRINGERPLUS 2016; 5:157. [PMID: 27026854 PMCID: PMC4766142 DOI: 10.1186/s40064-016-1880-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/16/2016] [Indexed: 12/27/2022]
Abstract
To clarify the hemodynamic changes under balloon occlusion of the hepatic artery and to identify predictors of the short-term therapeutic effect (TE) after balloon-occluded transcatheter arterial chemoembolization using miriplatin (B-TACE) for hepatocellular carcinoma (HCC). Tumor variables and angiographic data were collected for 35 nodules (29 patients) with a B-TACE for HCC. Lesions were classified into three groups based on the balloon-occluded CT hepatic arteriography (BO-CTHA) results: Group A, presence of corona enhancement; Group B, absence of corona enhancement; Group C, decreased perfusion or perfusion defect compared to standard CTHA. Objective response was defined as TE3/4, and poor TE as TE1/2, evaluated by response evaluation criteria in cancer of the liver at 1–4 months after the procedure. Univariate analysis revealed that proximal level of balloon occlusion, intratumoral lower CT values immediately after treatment and BO-CTHA findings were significantly correlated with poor TE (p = 0.034, 0.037, and 0.003, respectively). Multivariate logistic analysis identified the Group C as a significant factor associated with the worse short term TE (odds ratio 8.34; 95 % confidence interval 1.49–68.8). Partial or complete perfusion defect on BO-CTHA was an independent factor associated with poor therapeutic effect.
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Affiliation(s)
- Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Yukihisa Takayama
- Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Koichiro Morita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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Chen Y, Li H, Jiang X, Chen D, Ni J, Sun H, Luo J, Yao H, Xu L. Regional thermochemotherapy versus hepatic arterial infusion chemotherapy for palliative treatment of advanced hilar cholangiocarcinoma: a retrospective controlled study. Eur Radiol 2016; 26:3500-9. [PMID: 26822373 DOI: 10.1007/s00330-016-4208-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/12/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To retrospectively assess the efficacy of regional thermochemotherapy (TCT) compared with hepatic arterial infusion chemotherapy (HAIC)-alone for palliative treatment of advanced hilar cholangiocarcinoma (HC) and to determine the prognostic factors associated with survival. METHODS Forty-three consecutive patients with advanced HC underwent regional TCT (TCT group) and HAIC (HAIC group). We analyzed baseline characteristics, overall survival (OS), progression-free survival (PFS), stent patency time (SPT), adverse events (AEs), and prognostic factors for OS between the two groups. RESULTS OS of patients treated with regional TCT was significantly longer compared to that of patients treated with HAIC (median OS: 20.3 vs. 13.2 months, P = 0.004), and SPT and PFS were significantly increased in the TCT group compared with the HAIC group (median SPT: 26.5 vs. 10.5 months, P < 0.001; median PFS: 16.5 vs. 10.2 months, P = 0.001). TCT and metal stent insertion were two independent prognostic factors associated with survival. The treatment-related AEs were tolerable and similar in the two groups, except for hilar pain (34.6 %) and skin rashes (24.6 %) in the TCT group. CONCLUSIONS Our results show that regional TCT is safe and more effective than HAIC-alone and may be a promising option for palliative treatment of advanced HC. Metal stenting before TCT appears to improve patients' OS. KEY POINTS • Regional TCT is a novel combination for palliative treatment of advanced HC • Our data showed significantly promising outcomes in the TCT group • HC patients with metal stenting appeared to derive greater benefit from TCT.
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Affiliation(s)
- Yaoting Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Huiqing Li
- Health Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Xiongying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Dong Chen
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Jiayan Ni
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Hongliang Sun
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Jianghong Luo
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Herui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
| | - Linfeng Xu
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu Region, Guangzhou, Guangdong, 510120, People's Republic of China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, Guangdong, 510120, People's Republic of China.
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Preoperative Coil Embolization in Patients With a Replaced Hepatic Artery Scheduled for Pancreatectomy With Splanchnic Artery Resection Helps to Prevent Ischemic Organ Injury. J Comput Assist Tomogr 2016; 40:172-6. [DOI: 10.1097/rct.0000000000000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Yoshimatsu R, Yamagami T, Ishikawa M, Kajiwara K, Aikata H, Chayama K, Awai K. Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2015; 39:865-74. [PMID: 26711803 DOI: 10.1007/s00270-015-1279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/22/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE). METHODS Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated. RESULTS Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor. CONCLUSIONS Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.
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Affiliation(s)
- Rika Yoshimatsu
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.,Department of Radiology, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. .,Department of Radiology, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan.
| | - Masaki Ishikawa
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kenji Kajiwara
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Vesselle G, Quirier-Leleu C, Velasco S, Charier F, Silvain C, Boucebci S, Ingrand P, Tasu JP. Predictive factors for complete response of chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma. Eur Radiol 2015; 26:1640-8. [PMID: 26455721 DOI: 10.1007/s00330-015-3982-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify clinical and imaging features associated with complete response (CR) to first session of transarterial chemoembolization (TACE) with drug-eluting beads (DEB) in patients with hepatocellular carcinoma. METHODS In this prospective historical cohort, 172 patients with 315 tumours who received at least one DEB-TACE from 2007 to 2013 were studied. Imaging response was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Age, gender, aetiology of cirrhosis, Child and BCLC scores, particles size, location in the liver, size of the tumour, presence of a capsule, hypervascularisation on DSA and CT/MRI scans, and blush extinction were analysed. RESULTS After one session of treatment, CR was observed in 36 % of the 315 tumours treated. Nodule size, location in the liver, and complete blush extinction on DSA was statistically correlated to complete response, whereas capsule aspect on imaging and demographic criteria were not. In multivariate analysis only, location in the liver and nodule size were significant features. CONCLUSIONS Tumour location in the segments 1 and 4 is a pejorative factor for CR, whereas tumour size <5 cm is a positive predictive factor. These criteria could, therefore, be taken into consideration to improve the selection of patients for DEB-TACE. KEY POINTS • Literature on predictive factors of complete response after DEB-TACE is under-studied. • Tumour size <5 cm is associated with complete response. • Location in segments 1 or 4 is a pejorative factor for response. • No demographic parameter influences complete response.
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Affiliation(s)
- Guillaume Vesselle
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France.
| | - Camille Quirier-Leleu
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Stéphane Velasco
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Florian Charier
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Christine Silvain
- Department of Gastroenterology, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Samy Boucebci
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Pierre Ingrand
- Epidemiology and Biostatistics, Clinical Investigation Center INSERM CIC-P 802, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Jean-Pierre Tasu
- Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
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Matsumoto T, Endo J, Hashida K, Mizukami H, Nagata J, Ichikawa H, Kojima S, Takashimizu S, Yamagami T, Watanabe N, Hasebe T. Balloon-occluded arterial stump pressure before balloon-occluded transarterial chemoembolization. MINIM INVASIV THER 2015; 25:22-8. [PMID: 26406612 DOI: 10.3109/13645706.2015.1086381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate balloon-occluded arterial stump pressure (BOASP), which is responsible for effective balloon-occluded transarterial chemoembolization (B-TACE), at each hepatic arterial level before B-TACE using a 1.8-French tip microballoon catheter for unresectable hepatocellular carcinoma (HCC). MATERIAL AND METHODS The BOASP at various embolization portions was retrospectively investigated. "Selective" and "non-targeted" BOASP was defined as the BOASP at the subsegmental or segmental artery and the lobar artery, respectively. RESULTS The measurement of the BOASP was carried out in 87 arteries in 47 patients. BOASP > 64 mmHg was revealed in the caudate lobe artery (A1) and the left medial segmental (A4), right anterior superior segmental (A8), anterior segmental, right and left hepatic arteries. Significant difference was noted in the incidence of BOASP above 64 mmHg between "non-targeted" and "selective" BOASP (p = 0.01). "Non-targeted" BOASP was significantly greater than "selective" BOASP (p = 0.0147). In addition, the BOASP in A1, 4, 8 and the anterior segmental arteries were significantly greater than in the other subsegmental and segmental arteries (p = 0.0007). CONCLUSION "Non-targeted" B-TACE should be avoided to perform effective B-TACE and "selective" B-TACE at A1, 4, 8 and the anterior segmental arteries may become less effective than at the other segmental or subsegmental arteries.
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Affiliation(s)
- Tomohiro Matsumoto
- a Department of Radiology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan
| | - Jun Endo
- a Department of Radiology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan
| | - Kazunobu Hashida
- a Department of Radiology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan
| | - Hajime Mizukami
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Junko Nagata
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Hitoshi Ichikawa
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Seiichiro Kojima
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Shinji Takashimizu
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Takuji Yamagami
- c Department of Radiology , Kochi University , Kohasu, Oko-cho, Nankoku , Kochi , Japan
| | - Norihito Watanabe
- b Department of Gastroenterology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan , and
| | - Terumitsu Hasebe
- a Department of Radiology , Tokai University Hachioji Hospital, Tokai University School of Medicine , Tokyo , Japan
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Resection and reconstruction of the hepatic artery for advanced perihilar cholangiocarcinoma: result of arterioportal shunting. J Gastrointest Surg 2015; 19:675-81. [PMID: 25650165 DOI: 10.1007/s11605-015-2754-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 01/19/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical impact of concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma remains unclear. Microvascular anastomosis is typically used for arterial reconstruction, but we have proposed arterioportal shunting (APS) as an alternative procedure. The aims of this retrospective study were to evaluate concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma patients, to evaluate the safety and survival impact of APS, and to evaluate whether APS offers a good alternative to microvascular reconstruction. PATIENTS AND METHODS Thirty-nine patients with perihilar cholangiocarcinoma who required arterial reconstructions were retrospectively evaluated. RESULTS No significant difference was seen in overall incidence of postoperative complications between groups, but the incidence of liver abscess formation was significantly higher in the APS group. The cumulative 5-year survival rate was 15% in patients undergoing concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma. No significant differences in survival were identified between the microvascular (MV) and APS groups. Cumulative 5-year survival rates were 18% in the MV group and 11% in the APS group. CONCLUSION Concomitant arterial resection and reconstruction are feasible for patients with perihilar cholangiocarcinoma. Microvascular reconstruction should be used as the first-line strategy for these patients, with APS indicated only when the artery is unable to be microscopically anastomosed.
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Ishikawa T, Abe S, Inoue R, Sugano T, Watanabe Y, Iwanaga A, Seki K, Honma T, Nemoto T, Takeda K, Yoshida T. Predictive factor of local recurrence after balloon-occluded TACE with miriplatin (MPT) in hepatocellular carcinoma. PLoS One 2014; 9:e103009. [PMID: 25047920 PMCID: PMC4105420 DOI: 10.1371/journal.pone.0103009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/24/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Miriplatin (MPT) is a novel platinum complex used in TACE that shows promise for the treatment of hepatocellular carcinoma (HCC). However, rapid washout has been reported in some cases. Therefore, various methods of administration with MPT have been attempted to increase its therapeutic efficacy. One hopeful method is balloon-occluded TACE (B-TACE), but the therapeutic efficacy of B-TACE with MPT has not been evaluated. AIM To investigate the treatment outcomes and factors involved in local recurrence after B-TACE with MPT in HCC. METHODS This study included 51 patients (55 nodules) with HCC lesions equal or less than 5 cm in diameter who underwent B-TACE with MPT between January 2012 and June 2013. Local recurrence after B-TACE with MPT and factors associated with local recurrence were evaluated. RESULTS The overall local recurrence rate was 11.1% at 6 months and 26.2% at 12 months. The local recurrence rate did differ significantly depending on CT values immediately after B-TACE with MPT. Multivariate analysis also showed that the CT value after B-TACE with MPT was the only factor related to local recurrence after B-TACE. CONCLUSIONS B-TACE with MPT achieves relatively good local control of HCC. The plain CT value immediately after B-TACE with MPT is a predictive factor for local recurrence. In patients with unsatisfactory CT values, locoregional therapy or additional treatment is required.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Satoshi Abe
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Ryousuke Inoue
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Tomoyuki Sugano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Yuhsuke Watanabe
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Keiichi Seki
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Takeo Nemoto
- Department of Radiology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Keiko Takeda
- Department of Radiology, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan
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Mine T, Murata S, Ueda T, Takeda M, Onozawa S, Yamaguchi H, Kawano Y, Kumita SI. Contribution of extrahepatic collaterals to liver parenchymal circulation after proper hepatic artery embolization. J Gastroenterol Hepatol 2014; 29:1515-21. [PMID: 24628501 DOI: 10.1111/jgh.12571] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM To retrospectively evaluate proper hepatic artery embolization, with respect to the development of extrahepatic collaterals. METHODS Proper hepatic artery embolization was performed in 18 patients with hemorrhagic arterial lesions in the hepatic hilum. Post-procedural development of extrahepatic collaterals was evaluated by computed tomography or angiography. Embolization data and liver function tests were assessed. The correlation of outcomes with portal venous stenosis, hepatic failure prior to embolization, elevation of prothrombin time, and insufficient collateral development were analyzed. RESULTS Postoperative bleeding occurred in 17/18 patients, and one was treated for an idiopathic aneurysm of the proper hepatic artery; all treatments achieved technical success. Extrahepatic collaterals were confirmed in 13 patients. Elevations of liver function test values were transient and returned to baseline within 14 days in patients with collateral development (n = 13), but were unimproved in patients without collaterals (n = 5) (P < 0.001). Portal venous stenosis; prior hepatic failure; unrecovered, elevation of prothrombin time; and insufficient collateral development were significantly correlated with poor outcomes (P < 0.05, respectively). CONCLUSIONS Proper hepatic artery embolization is effective for hemostasis, and extrahepatic collateral development is expected. Therefore, this is a safe treatment without prolonged hepatic ischemic damage, especially in patients without severe portal venous stenosis or prior hepatic failure.
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Affiliation(s)
- Takahiko Mine
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
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