Optimal introduction of laparoscopic liver resection for Child–Pugh B

Fuji, Hisakazu; Seo, Satoru; Toda, Ryo; Ikeno, Yoshinobu; Fukumitsu, Ken; Ishii, Takamichi; Taura, Kojiro; Hatano, Etsuro; Kaido, Toshimi; Üemoto, Shinji

doi:10.1111/ases.12634

Cited by 11 publications

(4 citation statements)

References 21 publications

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“…LR in Child-Pugh B cirrhosis has been reported as an alternative treatment to LT, with promising short and long-term outcomes[ 72 , 73 ]. Moreover laparoscopic LR can be safely performed in selected Child-Pugh B patients with acceptable perioperative outcomes, although to date long-term results are not available[ 80 - 83 ]. Further studies are needed to clarify which Child-Pugh B patients with HCC are suitable candidates for laparoscopic LR, hoping to optimize the chances of long-term survival[ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a single institution series reported LRs in Child-Pugh B and C cirrhotic patients with acceptable results. To date, these data are scarce and come mainly from Asian studies[ 80 - 83 ]. Brytska et al [ 81 ] performed a subgroup analysis in advanced cirrhotic patients undergoing laparoscopic resection for HCC, including 13 Child-Pugh B and 3 Child-Pugh C patients.…”

Section: Liver Resection In Child-pugh B Cirrhosis Patientsmentioning

confidence: 99%

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Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Romano¹,

Chiarelli²,

Garancini³

et al. 2021

WJG

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According to Barcelona Clinic Liver Cancer recommendations, intermediate stage hepatocellular carcinomas (stage B) are excluded from liver resection and are referred to palliative treatment. Moreover, Child-Pugh B patients are not usually candidates for liver resection. However, many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection, maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function. Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification, and this treatment gives good results in the setting of multinodular, large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis. In this review we explore this controversial topic, and we show through the literature analysis how liver resection may improve the short- and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients. However, other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.

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Section: Discussionmentioning

confidence: 99%

Section: Liver Resection In Child-pugh B Cirrhosis Patientsmentioning

confidence: 99%

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Romano¹,

Chiarelli²,

Garancini³

et al. 2021

WJG

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“…The surgical procedures used in the study have been described in previously published articles [ 5 – 7 ]. In open hepatectomy, hepatic resection was performed using a Mercedes incision or an inverted L-shaped incision.…”

Section: Methodsmentioning

confidence: 99%

Structure and surgical dissection layers of the bare area of the liver

et al. 2020

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Background: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. Methods: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. Results: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. Conclusions: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.

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“…The surgical procedures used in the study have been described in previously published articles [5][6][7].…”

Section: Surgical Procedures and Patient Carementioning

confidence: 99%

Structure and surgical dissection layers of the bare area of the liver

Ishii

Seo

Ito

et al. 2020

Preprint

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Background: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.Methods: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. Results:The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. Conclusions:Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.

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Optimal introduction of laparoscopic liver resection for Child–Pugh B

Abstract: In the treatment of Child-Pugh B liver malignancy, the minimal invasiveness of LLR was revealed. Our results suggest that lesions in the left lateral segment and exophytic tumors are good indications for LLR for Child-Pugh B.

Cited by 11 publications

References 21 publications

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Structure and surgical dissection layers of the bare area of the liver

Structure and surgical dissection layers of the bare area of the liver

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