AimCombined hepatocellular cholangiocarcinoma (cHCC‐CCA) is a very rare subtype of primary liver carcinoma; therefore, its clinicopathological characteristics have not yet been elucidated in detail. The aim of the study was to reveal the clinicopathological characteristics and prognostic factors of cHCC‐CCA after hepatic resection (HR)MethodsA total of 124 patients who underwent curative HR for cHCC‐CCA between 2000 and 2016 were enrolled in this multi‐institutional study conducted by the Kyushu Study Group of Liver Surgery. Clinicopathological analysis was performed from the viewpoint of patient prognosis.ResultsA total of 62 patients (50%) had early recurrence within 1.5 years after HR, including 36 patients (58%) with extrahepatic recurrence. In contrast, just four patients (3%) had late recurrence occurring >3 years after HR. The independent predictors of early recurrence were as follows: des‐gamma carboxyprothrombin >40 mAU/mL (odds ratio 26.2, P = 0.0117), carbohydrate antigen 19–9>37 IU/l (odds ratio 18.0, P = 0.0200), and poorly differentiated HCC or CCA (odds ratio 11.2, P = 0.0259).ConclusionsHalf of the patients with cHCC‐CCA had early recurrence after HR. Preoperative elevation of des‐gamma carboxyprothrombin or carbohydrate antigen 19–9 and the existence of poorly differentiated components of HCC or CCA in resected specimens are predictors of its early recurrence.
Bacterial contamination of intra-abdominal discharge is a risk factor for the development of pancreatic fistulae. Cases involving contamination with Pseudomonas aeruginosa warrant extreme caution.
BackgroundAlthough left hemihepatectomy has been widely performed via the laparoscopic approach, the roles of the assistant surgeon have not been well-documented so far. We herein present our standardized procedures of laparoscopic left hemihepatectomy without Spiegel's lobe resection, focusing on the crucial roles of the assistant surgeon.
MethodsDuring laparoscopic left hemihepatectomy without Spiegel's lobe resection, countertraction by the assistant surgeon is quite important especially during isolating the left Glissonean pedicle and transecting liver parenchyma. When securing the left hepatic pedicle using the Glissonean approach, the assistant surgeon pushes Segment 4 of the liver cranially and pulls the tape encircling the hepatoduodenal ligament caudally in the opposite way, orthogonal to the direction of the laparoscopic forceps toward the left portal triad. During liver parenchymal transection, the assistant surgeon pulls the hanging tape across the left lobe of the liver in order to provide a wide and stable liver transection plane.With this standardized technique, nine cases of laparoscopic left hemihepatectomy were performed over the last two years in our department, and the perioperative data were retrospectively analyzed.
ResultsThe median age of the nine patients was 70 years (range: 58 -84 years). Most of the patients were males (77.8%). Five of nine patients were diagnosed with colorectal liver metastasis, two with hepatocellular carcinoma (HCC), one with inflammatory pseudotumor, and the other one with hepaticolithiasis. There were no conversions to open surgery. The median operative time and estimated blood loss were 337 minutes (range: 219 -478 minutes) and 100 ml (range: 41 -375 ml), respectively. The median length of postoperative hospital stay was nine days (range: 7 -16 days). Major complications (Clavien-Dindo classification grade III or more) were not encountered in our cohort postoperatively.
ConclusionWe presented here our standardized assistant roles during laparoscopic left hemihepatectomy without Spiegel's lobe resection, which was revealed to be safe and feasible in our cohort.
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