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Aoki H, Ito T, Hirata M, Kadohisa M, Yamamoto M, Uebayashi EY, Shirai H, Okumura S, Masano Y, Ogawa E, Okamoto T, Okajima H, Hatano E. Effects of Adding Congested Segment IV to the Left Lateral Graft on Short-term Outcomes in Pediatric Living-donor Liver-transplant Recipients. Transplant Direct 2023; 9:e1551. [PMID: 37876916 PMCID: PMC10593261 DOI: 10.1097/txd.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Background In some pediatric patients undergoing living-donor liver transplantation, segment IV without the middle hepatic vein can be added to a left lateral segment graft to obtain larger graft volume. Because no clear consensus on this technique exists, this study investigated the effects of congested areas on postoperative outcomes in pediatric patients with biliary atresia undergoing living-donor liver transplantation. Methods We retrospectively reviewed data of recipients with biliary atresia aged ≤15 y who had undergone living-donor liver transplantation at Kyoto University Hospital between 2006 and 2021 and with graft-to-recipient weight ratios (GRWR) of ≤2%. Based on the percentage of congested area in the graft, patients were classified into the noncongestion (n = 40; ≤10%) and congestion (n = 13; >10%) groups. To compare the differences between groups with similar nooncongestive GRWRs and investigate the effect of adding congested areas, patients in the noncongestion group with GRWRs of ≤1.5% were categorized into the small noncongestion group (n = 24). Results GRWRs and backgrounds were similar between the noncongestion and congestion groups; however, patients in the congestion group demonstrated significantly longer prothrombin times, higher ascites volumes, and longer hospitalization. Further, compared with the small noncongestion group, the congestion group had significantly greater GRWR and similar noncongestive GRWR; however, the congestion group had significantly longer prothrombin time recovery (P = 0.020, postoperative d 14), higher volume of ascites (P < 0.05, consistently), and longer hospitalization (P = 0.045), requiring significantly higher albumin and gamma-globulin transfusion volumes than the small noncongestion group (P = 0.027 and P = 0.0083, respectively). Reoperation for wound dehiscence was significantly more frequent in the congestion group (P = 0.048). Conclusions In pediatric liver-transplant recipients, adding a congested segment IV to the left lateral segment to obtain larger graft volume may negatively impact short-term postoperative outcomes.
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Affiliation(s)
- Hikaru Aoki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hirata
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Kadohisa
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miki Yamamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Hisaya Shirai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Masano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Ogawa
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Okamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatric Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yang J, Rhu J, Kwon J, Choi GS, Kim JM, Jeong WK, Joh JW. Hepatic venous territory mapping in living donor liver transplantation using right liver graft: an objective parameter for venous reconstruction. Ann Surg Treat Res 2023; 104:348-357. [PMID: 37337606 PMCID: PMC10277178 DOI: 10.4174/astr.2023.104.6.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose This study evaluated the clinical implication of hepatic venous territory mapping in living donor liver transplantation. Methods Living donor liver transplantations performed using right graft since 2017 were included. Hepatic venous volume mapping was started in 2019. Risk factors for graft failure and overall survival were analyzed. Analysis for factors related to occlusion of reconstructed vein was performed. Results Among 445 patients included, 213 underwent hepatic venous mapping. Hepatic venous mapping itself was not a significant factor for graft (hazard ratio [HR], 0.958; 95% confidence interval [CI], 0.441-2.082; P = 0.913) and overall survival (HR, 0.627; 95% CI, 0.315-1.247; P = 0.183). Inferior hepatic vein occlusion was a significant risk factor for both graft survival (HR, 8.795; 95% CI, 1.628-47.523; P = 0.012) and overall survival (HR, 11.13; 95% CI, 2.460-50.300; P = 0.002). In a subgroup with middle hepatic vein reconstruction, occlusion was a significant risk factor for overall survival (HR, 3.289; 95% CI, 1.304-8.296; P = 0.012). In patients with middle hepatic vein reconstruction whose venous territory volumes were measured, right anterior volume of ≥300 cm3 was protective for vein occlusion (OR, 0.317; 95% CI, 0.152-0.662; P = 0.002). In patients with V5 reconstruction, V5 volume of ≥150 cm3 was protective for vein occlusion (OR, 0.253; 95% CI, 0.087-0.734; P = 0.011). Conclusion Inferior and middle hepatic vein reconstruction has significant impact on clinical outcome. Hepatic venous territory mapping can provide an objective measure for successful reconstruction of venous branches.
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Affiliation(s)
- Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zakaria HM, Gad EH, Gaballa NK, Sallam AN, Ayoub II, Eltabbakh M, Elkholy SS, Abokoura S, Yassein T, Hegazy O, Abdelmeguid Shoreem H, Mohamed Soliman HE, Aziz AA, Taha M. Successful use of venous graft from native liver with hepatocellular carcinoma during living donor liver transplantation with no impact on recurrence rate: A retrospective cohort study. Ann Med Surg (Lond) 2022; 82:104714. [PMID: 36268362 PMCID: PMC9577848 DOI: 10.1016/j.amsu.2022.104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction There are still debates regarding using portal vein (PV) from liver with hepatocellular carcinoma (HCC) for vascular reconstruction. This study aimed to assess the feasibility and patency of PV venous graft from an explanted liver with HCC for the reconstruction of the hepatic veins tributaries or PV in living donor liver transplantation (LDLT) and to see if it has any risk on recurrence of HCC. Patient and methods We conducted a retrospective study on 81 patients with HCC who underwent LDLT from April 2004 to July 2022. Results Venous graft from native liver PV was used for vascular reconstruction in 31 patients as follows; reconstruction of V5 in 7 patients, V8 in 4 patients, V6 in 3 patients, combined V5 and V8 in 4 patients, V6 with V5/V8 in 5 patients, and as Y shape venous graft for 2 PV reconstruction in 8 patients. The implantation of the new conduit PV graft after reconstruction of the anterior sector tributaries was direct to the IVC in 8 patients, and to the common orifice of the left and middle hepatic veins in 12 patients. The 1 month, 3 months, and 1-year overall patency of the venous graft was 93.5%, 90.3%, and 84%, respectively. Nine patients had recurrent HCC. In multivariate analysis, the independent risk factors for HCC recurrence were AFP >400 ng/mL (HR = 1.47, 95% CI: 1.69–2.31, P = 0.01), moderate/poor differentiated tumor (HR = 3.06, 95% CI: 2.58–6.29, P = 0.02), and microvascular invasion (HR = 2.51, 95% CI: 1.05–1.93, P = 0.01). Using a PV venous graft had no risk factor for HCC recurrence (P = 0.9). Conclusion The use of PV venous graft of native liver with HCC for venous reconstruction is a feasible and valuable option in LDLT with good patency rates and no risk of HCC recurrence. The use of PV venous graft of native liver with HCC for venous reconstruction is a feasible and valuable option in LDLT. It has good patency rates and no risk on HCC recurrence. The independent risk factors for HCC recurrence in our study were AFP >400 ng/mL, moderate/poor differentiated tumor, and microvascular invasion.
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Xia Z, Zhao Y, Zhao H, Zhang J, Liu C, Lu W, Wang L, Chen K, Yang J, Zhu J, Zhao W, Shen A. Serum alanine aminotransferase to hemoglobin ratio and radiological features predict the prognosis of postoperative adjuvant TACE in patients with hepatocellular carcinoma. Front Oncol 2022; 12:989316. [PMID: 36185225 PMCID: PMC9523401 DOI: 10.3389/fonc.2022.989316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the prognostic value of radiological features and serum indicators in patients treated with postoperative adjuvant transarterial chemoembolization (PA-TACE) and develop a prognostic model to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC) treated with PA-TACE. Method We enrolled 112 patients (75 in the training cohort and 37 in the validation cohort) with HCC treated with PA-TACE after surgical resection at the Affiliated Hospital of Nantong University between January 2012 and June 2015. The independent OS predictors were determined using univariate and multivariate regression analyses. Decision curve analyses and time-dependent receiver operating characteristic curve analysis was used to verify the prognostic performance of the different models; the best model was selected to establish a multi-dimensional nomogram for predicting the OS of HCC patients treated with PA-TACE. Result Multivariate regression analyses indicated that rim-like arterial phase enhancement (IRE), peritumor capsule (PTC), and alanine aminotransferase to hemoglobin ratio (AHR) were independent predictors of OS after PA-TACE. The combination of AHR had the best clinical net benefit and we constructed a prognostic nomogram based on IRE, PTC, and AHR. The calibration curve showed good fit between the predicted nomogram’s curve and the observed curve. Conclusion Our preliminary study confirmed the prognostic value of AHR, PTC, and IRE and established a nomogram that can predict the OS after PA-TACE treatment in patients with HCC.
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Affiliation(s)
- Zicong Xia
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Yulou Zhao
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Hui Zhao
- Department of Interventional Radiology, Afiliated Hospital of Nantong University, Nantong, China
| | - Jing Zhang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Cheng Liu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Wenwu Lu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Lele Wang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Kang Chen
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Junkai Yang
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Jiahong Zhu
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
| | - Wenjing Zhao
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Aiguo Shen, ; Wenjing Zhao,
| | - Aiguo Shen
- Cancer Research Center Nantong, Tumor Hospital Affiliated to Nantong University, Medical School of Nantong University, Nantong, China
- *Correspondence: Aiguo Shen, ; Wenjing Zhao,
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Li L, Xu L, Zhou S, Wang P, Zhang M, Li B. Tumour site is a risk factor for hepatocellular carcinoma after hepatectomy: a 1:2 propensity score matching analysis. BMC Surg 2022; 22:104. [PMID: 35313888 PMCID: PMC8935716 DOI: 10.1186/s12893-022-01564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
Background The effect of the anatomic location of HCC on the prognosis of patients after hepatectomy is currently unclear. Methods Patients who underwent hepatectomy were retrospectively enrolled and divided into the right tumour resection group (R group) and the left tumour resection group (L group) according to the tumour anatomic location. To avoid bias, 1:2 propensity score matching (PSM) analysis was used. Based on the survival data, disease-free survival (DFS) and overall survival (OS) were evaluated by the Kaplan–Meier method, and long-term survival analysis was performed. Cox proportional hazards regression was used to analyse the risk factors associated with postoperative prognosis. Results A total of 700 patients were enrolled in our study. After 1:2 PSM, 354 and 177 patients were enrolled in the R group and the L group, respectively, with comparable baseline characteristics. Survival analysis showed that patients in the L group had a significantly higher recurrence rate than patients in the R group (P = 0.036), but there was no significant difference in the survival rate (P = 0.99). Long-term survival analysis showed that the survival rate of the L group was lower than that of the R group (P < 0.01). Multivariate analysis showed that tumour location in the left liver was an independent risk factor for tumour recurrence (hazard ratio, 1.263; 95% CI, 1.005–1.587) and long-term survival (hazard ratio, 3.232; 95% CI, 1.284–8.134). Conclusion For HCC patients, the recurrence rate and long-term survival rate of left liver tumours were significantly higher than those of right liver tumours, indicating that the anatomical location of the tumour has a significant effect on the survival of HCC patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2100052407. Registered 25 October 2021, http://www.chictr.org.cn/showproj.aspx?proj=135500.
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Affiliation(s)
- Lian Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Liangliang Xu
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Siqi Zhou
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Peng Wang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ming Zhang
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Bo Li
- Department of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Hong SY, Kim T, Kim M, Lee HY, Wang HJ, Kim BW. Strategy for Selective Middle Hepatic Vein Reconstruction in Living Donor Liver Transplantation Using Right Lobe Graft: A Retrospective Observational Study. Transplant Proc 2021; 53:2318-2328. [PMID: 34446307 DOI: 10.1016/j.transproceed.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to verify the safety and feasibility of our selection criteria for middle hepatic vein (MHV) reconstruction in living donor liver transplantation (LDLT) using right lobe grafts. METHODS A total of 153 LDLTs were performed using right lobe grafts in a tertiary hospital from 2006 to 2016. Among them, 52 cases without MHV reconstruction were compared with 101 recipients who underwent LDLT using right lobe graft with MHV reconstruction. Both groups were compared regarding indications for reconstruction, short-term and long-term complications, operative details, and outcomes. RESULTS The two groups differed only in cold ischemic time (108.19 ± 49.81 minutes vs 146.37 ± 58.74 minutes) preoperatively. Short-term posttransplant outcomes, long-term overall survival, and long-term disease-free survival showed no significant differences between the 2 groups. After propensity score matching for both groups with and without MHV reconstruction to eliminate selection bias, the 2 groups were comparable. CONCLUSIONS We found that our selection criteria for performing MHV reconstruction in LDLT using right lobe graft were feasible and safe. A routine MHV reconstruction is not necessary if the right lobe graft graft-to-recipient weight ratio is ≥1.0, right hepatic vein draining territory volume is ≥0.8, and recipient Model for End-Stage Liver Disease score is <20.
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Affiliation(s)
- Sung Yeon Hong
- Department of Surgery, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Taegyu Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Mina Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Young Lee
- Department of Biostatistics, Clinical Trial Center, Ajou University School of Medicine, Suwon, Korea
| | - Hee-Jung Wang
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Bong-Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, Korea.
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A Novel Technique for Bile Duct Division During Laparoscopic Living Donor Hepatectomy to Overcome Biliary Complications in Liver Transplantation Recipients: "Cut and Clip" Rather Than "Clip and Cut". Transplantation 2021; 105:1791-1799. [PMID: 32826797 DOI: 10.1097/tp.0000000000003423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was designed to analyze the clinical impact of a new bile duct division technique during laparoscopic living donor hepatectomy. METHODS Laparoscopic donor right hepatectomies performed by a single surgeon between December 2016 and August 2019 were included. Magnetic resonance cholangiopancreatography of the donors was reconstructed, and the length of the common channel of the dividing intrahepatic duct was measured. Patients were divided into 2 groups based on the bile duct division techniques of "clip and cut" versus "cut and clip." Outcome of bile duct division was categorized based on the graft and bile duct type and number of bile duct openings. RESULTS A total of 147 transplantations were included. Outcomes in the "cut and clip" group were better than those in the "clip and cut" group with regard to obtaining an adequate division point (94.2% versus 78.8%; P = 0.019). The "cut and clip" showed superior biliary stricture-free survival than the "clip and cut" group (hazard ratio [HR], 0.456; confidence interval [CI], 0.217-0.957; P = 0.038) whereas recipients with hepaticojejunostomy (HR, 3.358; CI, 1.090-10.350; P = 0.035) and bile duct type other than type I (HR, 2.214; CI, 1.143-4.289; P = 0.018) showed increased risk for biliary stricture-free survival. Better outcome in terms of obtaining a single opening was also obtained in the "cut and clip" group (68.2% versus 84.6%; P = 0.040), and this difference was significant especially with a common channel shorter than 10 mm (45.5% versus 81.2%; P = 0.043). CONCLUSIONS The "cut and clip" technique showed superior outcomes to the "clip and cut" technique in terms of fewer bile duct openings and biliary stricture-free survival of the recipients.
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Sun TG, Wang XJ, Cao L, Li JW, Chen J, Li XS, Liao KX, Cao Y, Zheng SG. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos). Surg Endosc 2021; 35:5352-5358. [PMID: 33835250 DOI: 10.1007/s00464-021-08455-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The paracaval portion of the caudate lobe is located in the core of the liver. Lesions originating in the paracaval portion often cling to or even invade major hepatic vascular structures. The traditional open anterior hepatic transection approach has been adopted to treat paracaval-originating lesions. With the development of laparoscopic surgery, paracaval-originating lesions are no longer an absolute contraindication for laparoscopic liver resection. This study aimed to evaluate the safety and feasibility of laparoscopic anterior hepatic transection for resecting paracaval-originating lesions. METHODS This study included 15 patients who underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection between August 2017 and April 2020. The perioperative indicators, follow-up results, operative techniques and surgical indications were retrospectively evaluated. RESULTS All patients underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection. The median operation time was 305 min (220-740 min), the median intraoperative blood loss was 400 ml (250-3600 ml), and the median length of postoperative hospital stay was 9 days (5-20 days). No conversion to laparotomy or perioperative deaths occurred. Six patients had Clavien grade III-IV complications (III/IV, 5/1). Two patients developed tumor recurrence after 13 months and 8 months. CONCLUSION Although technically challenging, laparoscopic anterior hepatic transection is still a safe and feasible procedure for resecting paracaval-originating lesions in select patients.
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Affiliation(s)
- Tian-Ge Sun
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Xiao-Jun Wang
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Li Cao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian-Wei Li
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Jian Chen
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Xue-Song Li
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Ke-Xi Liao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Yong Cao
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China
| | - Shu-Guo Zheng
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.
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Fan ST. Autologous graft from portal vein for reconstruction of the middle hepatic vein after hepatectomy. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sheung Tat Fan
- Liver Surgery and Transplant Centre Hong Kong Sanatorium and Hospital Happy Valley Hong Kong
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10
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Three-Dimensional Computed Tomography Scan Analysis of Anatomical Variations in the Hepatic Veins. Int Surg 2021. [DOI: 10.9738/intsurg-d-16-00077.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatic venous anatomy is a significant component of liver segmental anatomy, and its high variability is a challenge for hepatobiliary surgeons. This was a retrospective study of 98 consecutive patients with no cirrhosis or malignant tumors. IQQA-Liver software was used to display and analyze three-dimensional (3D) images of the hepatic veins and their branches and variations. The average liver volume was 1272.65 ± 322.04 mL; the left hepatic veins drained the smallest parts (21.13 ± 5.41%) of the liver compared with the right (35.58 ± 12.41%) and middle hepatic veins (34.64 ± 8.76%). The most common pattern was that the left hepatic veins shared a common trunk with the middle hepatic veins in 51cases (52.0%). The visualization rate of the inferior right hepatic vein (IRHV) was 43.9%, and its drainage volume was 179.27 ± 128.79 mL. In 11.2% of patients, the drainage volume for the IRHV was larger than for the right hepatic vein (RHV). The patterns of the left hepatic and middle hepatic veins were also observed and classified. Umbilical hepatic veins appeared in 75 cases (76.5%), and anterior fissure hepatic veins appeared in 74 cases (75.5%).The rate of the presence of a separate segment 4 vein was 15.3%, and 77 patients had obvious superficial veins. There was a statistically significant correlation between the diameter of the IRHVs and the drainage volume of the IRHVs and RHVs. More detailed information about the anatomical features and variations of hepatic venous veins in Chinese people was provided using 3D reconstructions, and this will assist in more precise liver surgeries.
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Rhu J, Kim JM, Jeong WK, Choi GS, Joh JW. Venous outflow congestion is related to poor recurrence-free survival of living donor liver transplantation recipients with hepatocellular carcinoma - a retrospective study. Transpl Int 2020; 34:272-280. [PMID: 33253442 DOI: 10.1111/tri.13792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/25/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
This study analyzed the impact of venous outflow congestion in the liver graft on hepatocellular carcinoma recurrence in liver transplantation recipients. Hepatocellular carcinoma patients who underwent living donor liver transplantation at Samsung Medical Center between 2007 and 2018 were included. The congested volume was calculated based on 2-week post-transplantation computed tomography. Recurrence-free survival and overall survival were analyzed using the multivariable Cox proportional hazard model including the degree of venous congestion. A total of 582 patients were included. There were 232 patients (39.9%) with certain degree of congestion volume. Kaplan-Meier survival analyses showed 1-, 5-, and 10-year recurrence-free survivals of 86.0%, 72.2%, and 70.7%, respectively, and overall survivals of 91.5%, 73.4%, and 68.9%, respectively. While congestion volume per 10 cm3 was a significant risk factor for recurrence-free survival (HR = 1.024, CI: 1.002-1.047, P = 0.034), there was no significant relationship with overall survival. (HR = 1.015, CI: 0.992-1.039, P = 0.213). Venous outflow congestion in the liver after living donor liver transplantation was related to the poor recurrence-free survival of hepatocellular carcinoma patients.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ke RS, Cai QC, Chen YT, Lv LZ, Jiang Y. Diagnosis and treatment of microvascular invasion in hepatocellular carcinoma. Eur Surg 2019. [DOI: 10.1007/s10353-019-0573-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Value of Two-Dimensional Shear Wave Elastography for Assessing Acute Liver Congestion in a Bama Mini-Pig Model. Dig Dis Sci 2018; 63:1851-1859. [PMID: 29736835 DOI: 10.1007/s10620-018-5085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date, liver congestion is one of the most significant clinical diseases. However, few studies have profoundly investigated the development, pathology, and prognosis of the important problems associated with acute hepatic congestion. AIMS To explore the value of noninvasive two-dimensional shear wave elastography (2D-SWE) for assessing acute liver congestion in an animal model. METHODS Six healthy Bama mini-pigs were used for this research and randomly divided into the experimental group and control group. We measured the basal liver stiffness (LS) by 2D-SWE and then clamped the inferior vena cava (IVC). LS was measured after 1, 5, 10, and 15 min. We reopened the IVC of experimental group pigs and detected the LS again. All pigs were killed and obtained for a pathological microscopic examination. RESULTS LS was distinctly increased from 7.03 ± 0.48 to 17.18 ± 3.40 kPa (p < 0.01) within 15 min and reversed to almost normal values of 7.59 ± 0.77 kPa (p < 0.01) within 5 min. In addition, two-dimensional ultrasound images demonstrated the interesting phenomenon of spontaneous echo contrast. Most importantly, the pathologic results of experimental group pigs showed the central veins of the hepatic lobules and hepatic sinusoids were enlarged and filled with numerous erythrocytes; central lobular hepatocytic necrosis and edema were noted. CONCLUSIONS In conclusion, 2D-SWE is a valuable, reliable, and quantitative approach to successfully assess acute liver congestion, and it is well consistent with histopathological characteristics. Besides, acute liver congestion is an important factor influencing LS that increases LS in a reversible way.
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Togashi J, Akamastu N, Kokudo N. Living donor liver transplantation for hepatocellular carcinoma at the University of Tokyo Hospital. Hepatobiliary Surg Nutr 2016; 5:399-407. [PMID: 27826554 DOI: 10.21037/hbsn.2016.08.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) is an established treatment not only for those with end-stage liver disease but for those with hepatocellular carcinoma (HCC) developing in cirrhotic liver. The aim of this study was to present a single-center experience of LDLT for HCC at the University of Tokyo Hospital, Japan. METHODS Among 573 liver transplant recipients from January 1996 until the end of 2015, 139 patients have been indicated LDLT for the treatment of HCC, and were the subjects of the present study. We use the expanded criteria for HCC as follows; the number of tumor should be five or less, and the maximum diameter of the tumor should be 5 cm or less, without the distant metastasis nor the vascular invasion (Tokyo criteria, 5-5 rule). We also focused on the identification of the incidental intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma/cholangiocarcinoma (cHCC-CC) in liver explants. RESULTS The overall 1-, 5-, and 10-year recurrence-free and patient survival rates were 95%, 91%, and 91%, 91%, and 80%, 78%, respectively. The 1-, 3-, and 5-year cumulative recurrence rate was 5%, 6%, and 6% for within Milan, 0%, 8%, and 8% for beyond Milan/within Tokyo, and 33%, 50%, and 50% for beyond Tokyo, respectively, demonstrating the significantly impaired outcome of those beyond Tokyo criteria (P<0.001). The high alpha-fetoprotein (AFP) value (≥400 ng/mL), the high des-gamma-carboxy prothrombin (DCP) value (≥200 mAU/mL) and beyond the Tokyo criteria were proved to be significant predictors for the HCC recurrence, but the size or the type of the partial graft was not associated. Incidental ICC and cHCC-CC were found in one and two patients, respectively, with the size of less than 2 cm in all cases. ICC was not detected in preoperative evaluation but cHCC-CCs were misdiagnosed as HCC preoperatively. All three patients were alive without recurrence with a follow-up period of 2 to 14 years. CONCLUSIONS The present results of our institution seem acceptable in terms of the recurrence-free and patient survival. The issues of the expansion of indication, living donor vs. deceased donor for HCC, and liver transplantation (LT) for cholangiocarcinoma are still left to be investigated in future studies.
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Affiliation(s)
- Junichi Togashi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamastu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo, Japan
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Lee DH, Lee JM, Yoon JH, Kim YJ, Han JK. Thermal Injury-induced Hepatic Parenchymal Hypoperfusion: Risk of Hepatocellular Carcinoma Recurrence after Radiofrequency Ablation. Radiology 2016; 282:880-891. [PMID: 27643670 DOI: 10.1148/radiol.2016152322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To retrospectively evaluate whether thermal injury-induced hepatic parenchymal hypoperfusion can be a significant risk factor for tumor recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Materials and Methods The institutional review board approved this retrospective study, and the requirement to obtain informed consent was waived. The study population comprised 130 patients (87 men, 43 women; mean age, 61.4 years ± 8.95; age range, 39-84 years) with single nodular HCCs smaller than 5 cm who underwent RFA between January 2011 and December 2012. The development of RFA-induced hepatic parenchymal hypoperfusion was assessed with follow-up computed tomography (CT). After a mean follow-up of 36.7 months ± 10.8, the authors analyzed the overall and recurrence-free survival and the cumulative incidence of each type of recurrence (ie, local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extrahepatic metastasis) by evaluating prognostic factors with use of the Kaplan-Meier method and Cox proportional hazard regression model. Results RFA-induced hepatic parenchymal hypoperfusion developed in 41 of the 130 patients (31.5%) but did not have a significant effect on overall survival (P = .634). However, the estimated 3-year recurrence-free survival rate was 43.3% in the 41 patients with RFA-induced hepatic parenchymal hypoxia and 61.9% in the 89 patients without hypoxia, a statistically significant difference (P = .019). The 3-year cumulative incidence of IDR was significantly higher in patients with RFA-induced hepatic parenchymal hypoperfusion than in those without hypoxia (33.3% vs 54.1%, P = .006). Conversely, the 3-year cumulative incidence of LTP and extrahepatic metastases showed no significant differences (P > .05 for both). Conclusion The development of RFA-induced hepatic parenchymal hypoperfusion is a significant predictive factor of recurrence (of IDR in particular) after RFA of a single nodular HCC. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Dong Ho Lee
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Jeong Min Lee
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Jung Hwan Yoon
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Yoon Jun Kim
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Joon Koo Han
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
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Pommergaard HC, Burcharth J, Rosenberg J, Rasmussen A. Serologic and molecular biomarkers for recurrence of hepatocellular carcinoma after liver transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando) 2016; 30:171-7. [PMID: 27118303 DOI: 10.1016/j.trre.2016.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/13/2016] [Accepted: 03/25/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC) is a major cause of mortality. Knowledge on biomarkers may contribute to better surveillance based on the patients' risk of recurrence. Reviewing the literature, we aimed to identify serological and molecular biomarkers for recurrence of hepatocellular carcinoma after liver transplantation. METHODS A literature search was performed in the databases PubMed and Scopus to identify observational studies evaluating serological or molecular biomarkers for recurrence of HCC after LT using adjusted analysis to correct for confounding. RESULTS Of 502 records, 69 mainly retrospective studies were included with a total of 15,213 patients. Of these, 41 studies were suitable for meta-analyses, which showed that the serum markers pre-transplant α-fetoprotein (AFP) (hazard ratio (HR) 2.69 [2.08-3.47]), pre-transplant des-gamma-carboxy prothrombin (DCP) (HR 5.99 [3.27-10.98]), and allelic imbalance in microsatellites in DNA of tumor tissue (HR 13.49 [3.17-57.30]) were related to recurrence. CONCLUSIONS AFP, DCP and allelic imbalance in microsatellites may be used to predict recurrence. Together with other modalities, biomarkers may be used in future transplantation criteria to optimize selection of suitable patients.
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Affiliation(s)
- Hans-Christian Pommergaard
- Hvidovre Hospital - University of Copenhagen, Department of Surgery, Kettegård Allé 30, 2650 Hvidovre, Denmark.
| | - Jakob Burcharth
- Herlev Hospital - University of Copenhagen, Department of Surgery, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Jacob Rosenberg
- Herlev Hospital - University of Copenhagen, Department of Surgery, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Allan Rasmussen
- Rigshospitalet - University of Copenhagen, Department of Surgical Gastroenterology and Transplantation, Abdominal Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Lin ZH, Li X, Hong YF, Ma XK, Wu DH, Huang M, Chen ZH, Chen J, Dong M, Wei L, Wang TT, Ruan DY, Lin ZX, Zhong X, Xing YF, Wen JY, Wu XY, Lin Q. Alanine aminotransferase to hemoglobin ratio is an indicator for disease progression for hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization. Tumour Biol 2015; 37:2951-9. [DOI: 10.1007/s13277-015-4082-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022] Open
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