Intraoperative ultrasonographic detection of communicating veins between adjacent hepatic veins during hepatectomy for tumours at the hepatocaval confluence

Torzilli, Guido; Garancini, Mattia; Donadon, Matteo; Cimino, Matteo; Procopio, Fabio; Montorsi, Marco

doi:10.1002/bjs.7230

Cited by 61 publications

(45 citation statements)

References 15 publications

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“…However, we did not experience a single case of congestion, and this is strictly related to the extensive use of EF-IOUS which has allowed the disclosure of communicating veins between adjacent hepatic veins in most patients with tumor located at the hepatocaval confluence. Indeed, in a recent report we have shown how communicating veins appear on EF-IOUS in 80% of such patients [23]. …”

Section: Discussionmentioning

confidence: 99%

From Mesohepatectomy to Mini-Mesohepatectomy: Evolving the Concept of Resectability of Hepatic Tumors at the Hepatocaval Confluence

Donadon

Torzilli

2011

Dig Surg

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In the case of tumors in contact with or invading the middle hepatic vein (MHV) at the hepatocaval confluence, extended right hepatectomy or mesohepatectomy is usually recommended. Major or extended hepatectomy is associated with significant rates of morbidity and mortality, and a more conservative approach would be desirable. Thus, we developed a new conservative operation, the so-called mini-mesohepatectomy that, in some specific circumstances, allowed the en-bloc resection of segment 8, segment 4-sup and the MHV at the hepatocaval confluence and at the same time preservation of the remaining parenchyma of the right anterior section and left median section drained by the MHV. The present work describes the rationale, indications, as well as the surgical technique of this new operation which we believe should be part of the armamentarium of the modern hepatic surgeon, and will probably limit the need for a formal mesohepatectomy.

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Section: Discussionmentioning

confidence: 99%

From Mesohepatectomy to Mini-Mesohepatectomy: Evolving the Concept of Resectability of Hepatic Tumors at the Hepatocaval Confluence

Donadon

Torzilli

2011

Dig Surg

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“…First, the surgical incision; in patients with tumors at the caval confluence or in the paracaval portion of S1, a J-shaped thoracoabdominal incision was carried out to control the backflow bleeding and to better position the left hand of the operator for guiding resection. Second, the intraoperative ultrasound was performed for staging and resection guidance [20]. Third, the whole liver mobilization was done to achieve complete vascular control and to define transection planes.…”

Section: Methodsmentioning

confidence: 99%

“…In case of superficial lesions, single-session multiple resections are commonly adopted, but in case of deep-located CLM, TSH is the preferred option. Torzilli et al [20-22] reported the possibility to perform E-OSH even in presence of deep-located lesions thanks to the combination of intraoperative ultrasound guidance, the detachment of metastases in contact with vessels, and the identification of communicating veins (CV) among hepatic veins (HV) to preserve an adequate outflow. This strategy minimized the need for parenchyma sacrifice and major hepatectomy [21, 23, 24].…”

Section: Introductionmentioning

confidence: 99%

Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers

et al. 2018

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Background: Two-stage hepatectomy (TSH) is the present standard for multiple bilobar colorectal metastases (CLM). As alternative, ultrasound-guided one-stage hepatectomy (E-OSH) has been proposed even for deep-located nodules to compare TSH and E-OSH. Methods: All consecutive TSH at the Paul Brousse Hospital and E-OSH at the Humanitas Research Hospital were considered. The inclusion criteria were ≥6 CLM, ≥3 CLM in the left liver, and ≥1 lesion with vascular contact. A total of 74 TSH and 35 E-OSH were compared. Results: The 2 groups had similar characteristics. Drop-out rate of TSH was 40.5%. In comparison with the cumulated hepatectomies of TSH, E-OSH had lower blood loss (500 vs. 1,100 mL, p = 0.009), overall morbidity (37.1 vs. 70.5%, p = 0.003), severe morbidity (14.3 vs. 36.4%, p = 0.04), and liver-specific morbidity (22.9 vs. 40.9%, p = 0.02). R0 resection rate was similar between groups. E-OSH and completed TSH had similar overall survival (5-year 38.2 vs. 31.8%), recurrence-free survival (3-year 17.6 vs. 17.7%), and recurrence sites. Conclusions: E-OSH is a safe alternative to TSH for multiple bilobar deep-located CLM. Whenever feasible, E-OSH should even be considered the preferred option because it has excellent safety and oncological outcomes equivalent to completed TSH, without the drop-out risk.

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“…However, hepatic vein resection even at caval confluence does not imply extension of the hepatectomy. Indeed, if accessory veins as an inferior right hepatic vein (IRHV) (16) or communicating veins (CV) (17) are present (Fig. 3), parenchyma sparing can be warranted anyway.…”

Section: Resection-guidancementioning

confidence: 99%

State of the Art of Intraoperative Ultrasound in Liver Surgery: Current Use for Resection-guidance

Torzilli¹,

Procopio²

2017

chr

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RezumatRealizarea intervenţiilor chirurgicale hepatice fără o strategie pentru protejarea parenchimului prezintă riscuri semnificative pentru supravieţuirea pacientului din cauza incidenţei ridicate de insuficienţă hepatică postoperatorie. În chirurgia hepatică modernă, utilizarea ecografiei intraoperatorii permite desfăşurarea aşa zisei "chirurgii radicale dar conservative", un factor esenţial pentru vindecarea unui procent ridicat de pacienţi, care până acum câţiva ani aveau o singură opţiune: îngrijirea paliativă. Prezentul articol detaliază motivaţia pentru folosirea ecografiei intraoperatorii pentru rezecţia sub ghidaj imagistic.Cuvinte cheie: ecografie intraoperatorie, rezecţie hepatică, hepatectomie AbstractThe performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. In the modern liver surgery the use of the intraoperative ultrasound (IOUS) allows the performance of the so-called "radical but conservative surgery", which is the pivotal factor to offer a chance of cure to an increasing proportion of patients, who until few years ago were considered only for palliative care. The present article details the rationale of IOUS for resection-guidance in liver surgery.

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Intraoperative ultrasonographic detection of communicating veins between adjacent hepatic veins during hepatectomy for tumours at the hepatocaval confluence

Abstract: EF-IOUS estimation of the frequency of communicating veins between adjacent hepatic veins suggests that such veins are common. This may facilitate parenchyma-sparing procedures in patients with hepatic tumours encroaching on major hepatic veins.

Cited by 61 publications

References 15 publications

From Mesohepatectomy to Mini-Mesohepatectomy: Evolving the Concept of Resectability of Hepatic Tumors at the Hepatocaval Confluence

From Mesohepatectomy to Mini-Mesohepatectomy: Evolving the Concept of Resectability of Hepatic Tumors at the Hepatocaval Confluence

Is Enhanced One-Stage Hepatectomy a Safe and Feasible Alternative to the Two-Stage Hepatectomy in the Setting of Multiple Bilobar Colorectal Liver Metastases? A Comparative Analysis between Two Pioneering Centers

State of the Art of Intraoperative Ultrasound in Liver Surgery: Current Use for Resection-guidance

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