Parenchyma-Sparing Liver Surgery for Large Segment 1 Tumors: Ultrasound-Guided Lateral and Superior Approaches as Safe Alternatives to Major Hepatectomy

Viganò, Luca; Costa, Guido; Procopio, Fabio; Donadon, Matteo; Cimino, Matteo; Fabbro, Daniele Del; Gatti, Andrea; Torzilli, Guido

doi:10.1016/j.jamcollsurg.2015.07.008

Cited by 20 publications

(16 citation statements)

References 37 publications

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“…6 Yang et al shown that anterior approach method is most optimal for single caudate lobectomy due to the advantages of full exposure of caudate lobe and low risks. 7 At present, people are constantly exploring surgical approach, and Vigano et al 8 proposed ultrasound guided side surgical approach or top surgical approach method for the resection of HCC located in caudate lobe of liver cancer in combination with intraoperative ultrasound for precise positioning, to treat HCC located in caudate lobe with large poor liver function, providing a new idea for clinical treatment of HCC in caudate lobe.…”

Section: Discussionmentioning

confidence: 99%

Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases

Zhang¹,

Wu²,

You³

et al. 2017

Int Surg J

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INTRODUCTIONPrimary hepatocellular carcinoma (HCC) is one of the most common digestive tract tumors, and surgical resection is the preferred therapeutic method of HCC. However, as caudate lobe is located in the middle of the back of liver, surrounded by a large number of large vessels, it is difficult and risky to resect.1 Many doctors attempted to adopt TACE-based non-operative method for the treatment of HCC located in the caudate lobe, but its clinical effects are controversial. In addition, with the continuous improvement of surgical approach, surgical method and surgical instruments, there are more and more reports on caudate lobe resection, but the long-term ABSTRACT Background: To investigate therapies of hepatocellular carcinoma in the caudate lobe, surgical approach and method, surgical outcome of hepatic caudate lobotomy. Methods: Clinical data of 13 patients with hepatocellular carcinoma in the caudate lobe who received surgical treatment in the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Chongqing Medical University from Jan 2010 to Jan 2014 was retrospectively analyzed. Results: Two patients selected TACE therapy. However, tumor metastasis was observed on them in short term, and the therapeutic effect was poor after several times of treatment. Nine patients received surgical treatment. Surgical approaches included left approach, right approach and combined approaches from the left and right side; surgical method was part or complete caudate lobe resection combining with other liver segments. The operation time was 220.0-350.0 minutes, with the average value of 259.4 minutes. The vascular clamping time was 21.0-45.0 minutes, with the average value of 30.2 minutes. The bleeding volume was 400.0-1800.0 ml, with the average value of 844.4 ml. In all patients, there was no perioperative death and no postoperative liver failure happened, and 4 patients who suffered from interrelated complications were cured or got better by conservative treatments. All patients were followed up for 24 months. The recurrent rates of 1 and 2-year were 44.4%, 88.9% respectively, and the survival rates of 1 and 2 year were 66.7%, 44.4% respectively after surgical resection. Conclusions: Resection is still the preferred therapeutic method for hepatocellular carcinoma in the caudate lobe. However, long-term outcomes of the therapy for hepatocellular carcinoma in the caudate lobe need further improvement.

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Section: Discussionmentioning

confidence: 99%

Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases

Zhang¹,

Wu²,

You³

et al. 2017

Int Surg J

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“…The authors' surgical technique has been previously reported [15,16,[18][19][20][21][22]. In brief, a parenchyma-sparing approach was routinely adopted.…”

Section: Patients' Management and Surgical Techniquementioning

confidence: 99%

Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases

et al. 2018

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Background: Patients with numerous colorectal liver metastases (CLM) have high risk of early recurrence after liver resection (LR). The presence of intrahepatic occult microscopic metastases missed by imaging has been hypothesized, but it has never been assessed by pathology analyses. Methods: All patients with > 10 CLM who underwent LR between September 2015 and September 2016 were considered. A large sample of liver without evidence of disease (“healthy liver”) was taken from the resected specimen and sent to the pathologist. One mm-thick sections were analyzed. Any metastasis, undetected by preoperative and intraoperative imaging, but identified by the pathologist was classified as occult microscopic metastasis. Results: Ten patients were prospectively enrolled (median number of CLM n = 15). In a per-lesion analysis, the sensitivity of computed tomography and magnetic resonance imaging was 91 and 98% respectively. The pathology examination confirmed all the CLM. All patients had an adequate sample of “healthy liver” (median number of examined blocks per sample n = 14 [5–33]). No occult microscopic metastases were detected. After a median follow-up of 15 months, 5 patients were disease-free. Recurrence was hepatic and bilobar in all patients. Conclusions: Clinically relevant occult microscopic disease in patients with numerous CLM is excluded. These results support the indication to resection in such patients and exclude the need for de principe major hepatectomy to increase the completeness of surgery.

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“…In the era of a multimodal approach to CLM, the definition of unresectability is evolving with the use of effective chemotherapy agents, in association with liver volume modulation strategies and parenchymal sparing techniques [15]. The strongest predictor of both disease free and overall survival is the pattern of response to preoperative chemotherapy.…”

Section: Surgery In Initially Unresectable Patientsmentioning

confidence: 99%

Recent Advances in Chemotherapy and Surgery for Colorectal Liver Metastases

et al. 2016

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Background: The liver is the most common site of metastases for colorectal cancer, and combined resection with systemic chemotherapy is the most effective strategy for survival. The aim of this article is to provide a comprehensive summary on four hot topics related to chemotherapy and surgery for colorectal liver metastases (CLM), namely: (1) chemotherapy-related liver injuries: prediction and impact, (2) surgery for initially unresectable CLM, (3) the emerging role of RAS mutations, and (4) the role of hepatic arterial infusion of chemotherapy (HAIC). Summary and Key Messages: (1) The use of chemotherapy before liver resection for CLM leads to drug-specific hepatic toxicity, which negatively impacts posthepatectomy outcomes. (2) Curative liver resection of initially unresectable CLM following conversion chemotherapy should be attempted whenever possible, provided that a safe future liver remnant volume is achieved. (3) For CLM, RAS mutation status is needed to guide the use of targeted chemotherapy with anti-epithelial growth factor receptor (EGFR) agents, and is a major prognostic factor that may contribute to optimize surgical strategy. (4) HAIC agents increase the rate of objective response and the rate of complete pathological response.

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Parenchyma-Sparing Liver Surgery for Large Segment 1 Tumors: Ultrasound-Guided Lateral and Superior Approaches as Safe Alternatives to Major Hepatectomy

Cited by 20 publications

References 37 publications

Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases

Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases

Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases

Recent Advances in Chemotherapy and Surgery for Colorectal Liver Metastases

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