Outflow modulation to target liver regeneration: Something old, something new

Balzan, Silvio Márcio Pegoraro; Gava, Vinícius Grando; Magalhães, Marcelo Arbo; Dotto, Marcelo Luiz

doi:10.1016/j.ejso.2013.08.012

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…From January 2013 to December 2015, patients (Table 1) with multiple bilateral CLM who underwent a two-stage hepatectomy with preservation of segment 4 [± segment 1 (S1)] only, using a technique previously described by our team[15], were selected for study inclusion and designated as the “congestion group”. For comparative analysis, patients that underwent right hepatectomy were selected to fit a 2: 1 case-matched proportion and included as the “comparison group”.…”

Section: Methodsmentioning

confidence: 99%

“…Modulated congestion of the left lobe associated with right hepatectomy led to a significant hypertrophy rate of segments 4 and 1 (156%) but only a modest hypertrophy rate of segments 2 and 3 (24%). Modified from Balzan et al[15]. …”

Section: Methodsmentioning

confidence: 99%

“…The ALPPS method was developed to induce hypertrophy of the left lateral section, in particular[13,14]. Recently, our group published a technical alternative option that optimizes hypertrophy of segment 4, while avoiding hypertrophy of the left lateral section and maintaining its function[15]. In this study, we aimed to target hypertrophy to segment 4 by generating a congestion of segments 2 and 3 after performance of a right hepatectomy.…”

Section: Introductionmentioning

confidence: 99%

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Extreme liver resections with preservation of segment 4 only

Balzan¹,

Gava²,

Magalhães³

et al. 2017

WJG

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AIMTo evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only.METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only (with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy (congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients (comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation.RESULTSThe two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103% (mean increase from 438 mL to 890 mL) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant (i.e., segment 4 ± S1) was higher than that of segments 2 and 3 (144% vs 54%, respectively, P < 0.05). The median remnant liver volume-to-body weight ratio was 0.3 (range, 0.28-0.40) before the first stage and 0.8 (range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3 (123% ± 47%) and of segment 4 (108% ± 60%, P > 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery.CONCLUSIONThe proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extreme liver resections with preservation of segment 4 only

Balzan¹,

Gava²,

Magalhães³

et al. 2017

WJG

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“…В норме объем паренхимы S IV составляет от 14 до 17% общего объема органа [23]. На современном этапе медицинских знаний предпосылки, включающие изучение особенностей регенераторного потенциала парен-химы печени [33], анатомии афферентных и эфферентных сосудов органа [31,34,35], гемодинамических характеристик кровоснабжения печени, позволило разработать методику двухэтапной экстремальной расширенной резекции печени с сохранением только 2 смежных сегментов (S IV и S I ) [16]. Метод предложен для лечения пациентов с колоректальными метастазами в печень в случаях с множественными синхронными метастазами в правой доле печени и сегментах левого латерального сектора [17].…”

Section: рис 2 фиксированный кадаверный препарат печени (диссекцияunclassified

“…Кроме того, развитие концепций паренхимосохраняющих расширенных резекций печени (сохранение части S IV печени) [14,15] и экстремально-расширенных резекций с сохранением только 2 смежных сегментов (S IV и S I ) печени [16,17] требуют углубленных знаний анатомии сегментов печени, их кровоснабжения и желчеоттока. Хирургами-гепатологами и сообществами трансплантологов стран Европы, Азии и Северной Америки в качестве стандарта при описании сегментов органа принята Анатомическая классификация строения печени C. Couinaud и H. Bismuth [18][19][20], основанная на внутрипеченочном распределении ветвей воротной вены.…”

Section: Introductionunclassified

Surgical anatomy of liver segment iv and its importance in hepatobiliary surgery

Zharikov

Kovalenko

Zharikova

et al. 2019

Khir. Z. im. N.I. Pirogova

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Цель исследования-описание клинической анатомии IV сегмента печени и определение ее значения в хирургии, а также комплексного подхода в лечении злокачественных новообразований этой локализации. Ключевые слова: хирургическая анатомия, сегмент S IV печени, злокачественные новообразования печени, хирургическое лечение.

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Choosing the Best Strategy

Ardiles

Santibañés

2017

Extreme Hepatic Surgery and Other Strategies

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Outflow modulation to target liver regeneration: Something old, something new

Cited by 16 publications

References 15 publications

Extreme liver resections with preservation of segment 4 only

Extreme liver resections with preservation of segment 4 only

Surgical anatomy of liver segment iv and its importance in hepatobiliary surgery

Choosing the Best Strategy

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