Techniques of Hepatectomy for Hepatocellular Carcinoma

Abstract

Intraoperative blood loss is well associated with the immediate outcome after hepatic resection particularly in cirrhotic patients. Temporary occlusion of the hepatic inflow (Pringle’s maneuver) effectively suppresses the blood loss and postoperative mortality. This technique is safe for 60-70 min in noncirrhotic and for 30 min in cirrhotic patients. Total vascular exclusion of the liver is rarely indicated but useful in resecting tumors adjacent to or growing in the main hepatic veins or inferior vena cava. Hypothermia may be used when the ischemic time is longer than the above-mentioned times. Extrahepatic control of the hepatic veins is possible in most cases. A Cavitron ultrasonic surgical aspirator is widely used to transect noncirrhotic livers but without diminishing blood loss. Autotransplantation of the liver with bench procedures may be indicated for only very selected patients. Although it is still controversial to place or not to place drains after hepatic resection, a routine drainage is probably not necessary.

Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer

“…However, TACE can also achieve good results, although it is not thought of as curative. Nagasue et al 9 also concluded that repeat hepatectomy may be useful for recurrent HCC, and they suggested that repeat hepatectomy was indicated principally for patients with a solitary tumor and Child grade A liver disease. These groups of authors [7][8][9] considered that repeat hepatic resection for recurrent HCC was beneficial, but they did not analyze recurrent HCC by distinguishing MC from IM.…”

“…Nagasue et al 9 also concluded that repeat hepatectomy may be useful for recurrent HCC, and they suggested that repeat hepatectomy was indicated principally for patients with a solitary tumor and Child grade A liver disease. These groups of authors [7][8][9] considered that repeat hepatic resection for recurrent HCC was beneficial, but they did not analyze recurrent HCC by distinguishing MC from IM. Here, we have reported the survival rates of 29 patients (who underwent a total of 31 second and third operations, including hepatectomy and MTC, for recurrent HCCs) according to the mode of recurrence.…”

Surgical treatment of hepatocellular carcinoma

“…Although recurrence following resection of HCC is associated with a poor outcome in most cases, there is growing evidence that some patients will benefit from more aggressive approaches, especially if the recurrence is limited to the liver [77][78][79]. Multimodality therapy including TACE, percutaneous ablative therapy, and re-resection could result in prolonged survival with an overall 5-year survival rate of 20% [30,71,73,80,81].…”

Characteristics of recurrent hepatocellular carcinoma in Japan and our surgical experience

“…Several studies have reported on repeat hepatectomy for intrahepatic recurrence. [2][3][4][5][6][7] According to the study of Poon et al, 7 the overall 1-year, 3-year, and 5-year survival rates from the time of recurrence were 65.5%, 34.9%, and 19.7%, respectively, and those from the time of initial hepatectomy were 78.4%, 47.2%, and 30.9%, respectively. They examined survival rates in relation to therapeutic modalities, and showed that the re-resection group had the best survival, followed by the transarterial chemoembolization group.…”