The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system

Wakabayashi, Go; Cherqui, Daniel; Geller, David A.; Hilal, Mohammed Abu; Berardi, Giammauro; Ciria, Rubén; Abe, Yuta; Aoki, Takeshi; Asbun, Horacio J.; Chan, Albert Chi‐Yan; Chanwat, Rawisak; Chen, Kuo‐Hsin; Chen, Yajin; Cheung, Tan To; Fuks, David; Gotohda, Naoto; Han, Ho‐Seong; Hasegawa, Kiyoshi; Hatano, Etsuro; Honda, Goro; Itano, Osamu; Iwashita, Yukio; Kaneko, Hironori; Kato, Yutaro; Kim, Ji Hoon; Liu, Rong; López‐Ben, Santiago; Morimoto, Mamoru; Monden, Kazuteru; Rotellar, Fernando; Sakamoto, Yoshihiro; Sugioka, Atsushi; Yoshiizumi, Tomoharu; Akahoshi, Keiichi; Alconchel, Felipe; Ariizumi, Shun‐ichi; Cacciaquerra, Andrea Benedetti; Durán, Manuel; Vázquez, Alain García; Golse, Nicolas; Miyasaka, Yoshihiro; Mori, Yasuhisa; Ogiso, Satoshi; Shirata, Chikara; Tomassini, Federico; Urade, Takeshi; Wakabayashi, Taiga; Nishino, Hitoo; Hibi, Taizo; Kokudo, Norihiro; Ohtsuka, Masayuki; Ban, Daisuke; Nagakawa, Yuichi; Ohtsuka, Takao; Tanabe, Minoru; Nakamura, Masafumi; Tsuchida, Akihiko; Yamamoto, Masakazu

doi:10.1002/jhbp.1091

Cited by 86 publications

(57 citation statements)

References 22 publications

(40 reference statements)

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“…The study population included all consecutive patients that underwent elective major hepatectomy at two Swedish tertiary centres for hepatopancreatobiliary surgery (Karolinska University Hospital, Stockholm and Linköping University Hospital, Linköping) between January 2010 and December 2018. Major hepatectomy was defined as resection of three or more liver segments according to Couinaud’s classification and trisectionectomy was defined as resection of five or more liver segments 10 . The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committees.…”

Section: Methodsmentioning

confidence: 99%

Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy

et al. 2022

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Background Post-hepatectomy liver failure (PHLF) is one of the most serious postoperative complications after hepatectomy. The aim of this study was to assess the impact of the International Study Group of Liver Surgery (ISGLS) definition of PHLF on morbidity and short- and long-term survival after major hepatectomy. Methods This was a retrospective review of all patients who underwent major hepatectomy (three or more liver segments) for various liver tumours between 2010 and 2018 at two Swedish tertiary centres for hepatopancreatobiliary surgery. Descriptive statistics, regression models, and survival analyses were used. Results A total of 799 patients underwent major hepatectomy, of which 218 patients (27 per cent) developed ISGLS-defined PHLF, including 115 patients (14 per cent) with ISGLS grade A, 76 patients (10 per cent) with grade B, and 27 patients (3 per cent) with grade C. The presence of cirrhosis, perihilar cholangiocarcinoma, and gallbladder cancer, right-sided hemihepatectomy and trisectionectomy all significantly increased the risk of clinically relevant PHLF (grades B and C). Clinically relevant PHLF increased the risk of 90-day mortality and was associated with impaired long-term survival. ISGLS grade A had more major postoperative complications compared with no PHLF but failed to be an independent predictor of both 90-day mortality and long-term survival. The impact of PHLF grade B/C on long-term survival was no longer present in patients surviving the first 90 days after surgery. Conclusions The presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival; however, even ISGLS grade A had clinical implications.

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Section: Methodsmentioning

confidence: 99%

Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy

et al. 2022

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“…Liver segments were defined according to Couinaud’s classification and the Brisbane nomenclature [ 16 ]. The removal of one Couinaud’s segment was defined as anatomic resection.…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive mesohepatectomy for centrally located liver lesions—a case series

et al. 2022

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Background Resection of centrally located liver lesions remains a technically demanding procedure. To date, there are limited data on the effectiveness and safety of minimally invasive mesohepatectomy for benign and malignant lesions. It was therefore the objective of this study to evaluate the perioperative outcomes of minimally invasive mesohepatectomy for liver tumors at a tertiary care hospital. Methods Consecutive patients who underwent a minimally invasive anatomic mesohepatectomy using a Glissonean pedicle approach from April 2018 to November 2021 were identified from a prospective database. Demographics, operative details, and postoperative outcomes were analyzed using descriptive statistics for continuous and categorical variables. Results A total of ten patients were included, of whom five patients had hepatocellular carcinoma, one patient had cholangiocarcinoma, three patients had colorectal liver metastases, and one patient had a hydatid cyst. Two and eight patients underwent robotic-assisted and laparoscopic resections, respectively. The median operative time was 393 min (interquartile range (IQR) 298–573 min). Conversion to laparotomy was required in one case. The median lesion size was 60 mm and all cases had negative resection margins on final histopathological analysis. The median total blood loss was 550 ml (IQR 413–850 ml). One patient had a grade III complication. The median length of stay was 7 days (IQR 5–12 days). Time-to-functional recovery was achieved after a median of 2 days (IQR 1–4 days). There were no readmissions within 90 days after surgery. Conclusion Minimally invasive mesohepatectomy is a feasible and safe approach in selected patients with benign and malignant liver lesions.

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“…During the period of the study, four hundred and eighty-seven hepatic resections were carried out by the individual HPB surgeon (A.K.S.). One hundred and seventy-six (36%) of these were classified as major (hemi-liver or more extensive) [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…The use of a frozen section was also recorded. The Tokyo update of the Brisbane nomenclature of liver resection was used, although right hepatectomy was not referred to as right bi-sectionectomy [ 11 , 13 ]. The term “extended” right hepatectomy was used when there was preservation of the lateral portion of IVa and part of IVb together with the origin of the middle hepatic vein.…”

Section: Methodsmentioning

confidence: 99%

Work-Up and Outcome of Hepatic Resection for Peri-Hilar Cholangiocarcinoma (PH-CCA) without Staging Laparoscopy

Jegatheeswaran

Stathakis

Spiers

et al. 2022

Cancers

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Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscopy. Methods: This is a clinical case cohort series of patients undergoing surgical resection of PH-CCA without the use of staging laparoscopy in the work-up algorithm. During the 13 years from 1 January 2009 to 1 January 2022, 32 patients underwent laparotomy for planned surgical resection of PH-CCA. Data were collected on demographic profile, admission biochemistry, radiology, pre-operative intervention, operation and outcome, together with post-operative complications and disease-free and overall survival. Results: All patients underwent pre-operative contrast-enhanced CT. Twenty-four (75%) underwent pre-operative MR. Twenty-three (72%) underwent pre-operative biliary drainage. Twenty-nine patients (91%) had either type III or IV peri-hilar cholangiocarcinoma. One patient (3%) in this series underwent a non-resectional laparotomy. Twenty-nine (91%) had a final histopathological diagnosis of PH-CCA. One further patient had a final diagnosis of an intraductal papillary neoplasm of the biliary tree (IPNB) with high-grade dysplasia but no invasive cancer. Eleven patients (36%) received chemotherapy after surgery. The median (95% CI) time to recurrence was 14 (7–31) months. The median survival was 25 (18-upper limit not reached) months. Conclusion: This cohort of 32 patients undergoing attempted resection for PH-CCA without the use of staging laparoscopy in the work-up algorithm indicates that with careful attention to patient fitness and cross-sectional and interventional radiologic/endoscopic imaging, a very low non-therapeutic laparotomy rate of 3% can be achieved and sustained.

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The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system

Cited by 86 publications

References 22 publications

Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy

Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy

Minimally invasive mesohepatectomy for centrally located liver lesions—a case series

Work-Up and Outcome of Hepatic Resection for Peri-Hilar Cholangiocarcinoma (PH-CCA) without Staging Laparoscopy

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