Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence

Torzilli, Guido; Montorsi, Marco; Fabbro, Daniele Del; Palmisano, Angela; Donadon, Matteo; Makuuchi, Masatoshi

doi:10.1002/bjs.5321

Cited by 106 publications

(66 citation statements)

References 50 publications

(28 reference statements)

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“…Computed tomography-assisted liver volumetry, preoperative portal vein embolization, anatomical surgery, intraoperative ultrasound-guided surgery, and parenchymal transection with (intermittent) inflow occlusion or even total vascular exclusion have all played important roles in safely extending the boundaries of partial liver resection. [33][34][35][36] Extensive liver resection, which leaves up to 20% of the normal functional liver volume, can be performed quite safely in these patients; this is evidenced by the low operative mortality rate, which ranges from 0% to 6.4%. The 1-and 5-year OS rates after liver resection for NC-HCC range from 62% to 97% and from 25% to 81%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one of these patients had FL-HCC, and only 6 had classical HCC. 33,34 The number of reported patients, the inclusion of patients with viral hepatitis and/or alcoholic liver disease, the OS, DFS, and recurrence rates, the operative mortality, the risk factors influencing survival, and tumor recurrence were analyzed. The literature review of the transplant experience for NC-HCC was completed for the 2010 consensus conference on LT for HCC (Zurich, Switzerland) with data obtained from a recent analysis of 105 liver recipients entered into the audited European Liver Transplant Registry (ELTR).…”

Section: Methodsmentioning

confidence: 99%

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Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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Hepatocellular carcinoma (HCC) is a relatively common cancer and occurs mainly in patients with liver cirrhosis (85%-95%). A significant number of cases are, however, diagnosed in normal and noncirrhotic/nonfibrotic livers. In contrast to HCC in a cirrhotic liver, noncirrhotic hepatocellular carcinoma (NC-HCC) predominantly occurs in young and healthy female patients in their 30s, and the diagnosis is frequently made at an advanced stage in the absence of a clear etiological factor. [1][2][3] The same holds true for the uncommon fibrolamellar hepatocellular carcinoma (FL-HCC) variant. [1][2][3] Several studies have shown that the 3-year overall survival (OS) rates with different pharmaceutical, radiological, and surgical therapies for HCC (if they are adequately performed) are approximately 60%. 4 After 3 years, the results of these treatments start to diverge substantially with respect to OS and, most importantly, with respect to disease-free survival (DFS). Long-term follow-up (5-10 years) has clearly shown that surgical resection is the only curative treatment for any kind of HCC. [2][3][4][5] With respect to very long-term DFS (>5 years), liver transplantation (LT) offers the best results. 2,4-6 In order to be successful, surgery has to be adapted to the tumor, the underlying condition of the patient, and the patient's liver. Liver resection and LT should have complementary roles rather than competing ones, and they should be associated with each other instead of being opposed. 5 Partial resection for HCC can be considered only for patients with well-compensated cirrhosis or fibrosis or with normal liver tissue. For patients with decompensated liver disease, cirrhosis, or a technically unresectable tumor, LT offers the best chance for a cure. This option indeed addresses the tumor as well as the underlying liver disease.Despite the extensive experience with LT for the treatment of HCC in patients with cirrhosis, the experience with LT for the treatment of NC-HCC is anecdotal and is limited to situations in which resection is not possible.The aims of this study were as follows: (1) to analyze the results from recent series of partial liver resections for NC-HCC, (2) to compare these results with the results of LT for the same condition; and (3) to propose an adaptation of the therapeutic algorithm for NC-HCC on the basis of these analyses.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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“…US control during the execution of the resection cut permits confirmation or modification of the trajectory in real time, thus making it possible to resort to resection strategies which would otherwise be too difficult or too risky [4,21]. Some authors report an elevated number of cases in which the advanced application of US-guided liver resection decisively contributes to achieving zero postoperative mortality and a major complications rate below 9% [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…US-guided resection therefore enhances safe and effective segmental [25,26] or subsegmental [18] resection, consequently reducing the number of major liver resections while keeping oncologic radicality unchanged [9,21]. Such a conservative and yet radical policy is vital in case of reduced liver functionality or in the presence of multiple lesions.…”

Section: Discussionmentioning

confidence: 99%

“…During resection the operating surgeon checked the dissection trajectory by IOUS, holding the probe with the right hand while the left hand fingertips, positioned behind the liver, were used as landmarks. The dissection plane appears on the IOUS image as an echoic line owing to the entrapment of air bubbles and clots between the 2 parenchymal portions defined by the section plane [21] (Fig. 3).…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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KEYWORDSIntraoperative ultrasonography; Liver resection; Hepatocellular carcinoma; Liver metastases.Abstract Introduction: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumorevessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. Methods: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. Results: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1e4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1e12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. Conclusions: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.Sommario Premessa: Nell'ambito della chirurgia epatica l'ecografia intraoperatoria svolge un ruolo ben codificato nella stadiazione e nella pianificazione della strategia operatoria. L'importanza dell'ampio utilizzo di questa metodica anche durante la resezione è stata riportata solo da alcuni autori. Questo studio ha come scopo di verificare quali siano i risultati a breve termine di un ampio utilizzo dell'ecografia durante la resezione stessa in un ospedale periferico. Metodi: Nell'arco di 24 mesi 11 pazienti consecutivi sono stati sottoposti a resezione epatica ecoguidata. I dati perioperatori sono stati raccolti in modo prospettico per valutare l'influenza di questa metodica sulla mortalità, morbidità e recidive locali. * Corresponding author. via Peschiera 40/7, 16122 Genova, Italia.E-mail address: pietrogrondona@yahoo.com (P. Grondona). Risultati: Otto pazienti erano maschi. Età mediana 74 anni. Quattro HCC, 4 metastasi, 1 colangiocarcinoma periferico, 1 emangioma, 1 pseudotumore infiammatorio. Sono state eseguite 3 resezioni a cuneo, 3 subsegmentectomie, 4 segmentectomie e 3 bisegmentectomie. La perdita ematica mediana è stata 235 ml. In caso di tumore il margine di exeresi mediano è st...

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Hepatectomy for Stage B and Stage C Hepatocellular Carcinoma in the Barcelona Clinic Liver Cancer Classification

Torzilli¹

2008

Arch Surg

138

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Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence

Abstract: IOUS allowed sparing of the liver parenchyma without tumour recurrence in most patients with a tumour involving a hepatic vein at the caval confluence, avoiding more extensive hepatectomy or vascular reconstruction.

Cited by 106 publications

References 50 publications

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

Ultrasound-guided liver resection: Early experience in a district general hospital

Hepatectomy for Stage B and Stage C Hepatocellular Carcinoma in the Barcelona Clinic Liver Cancer Classification

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