Liver Regeneration is Preserved After At Least Four Repeated Liver Resections for Hepatocellular Carcinoma

Electromagnetic Tracking and Optical Molecular Imaging Guidance for Liver Biopsy and Point-of-Care Tissue Assessment in Phantom and Woodchuck Hepatocellular Carcinoma

PURPOSE

To evaluate an integrated liver biopsy platform that combined CT image fusion, electromagnetic (EM) tracking, and optical molecular imaging (OMI) of indocyanine green (ICG) to target hepatocellular carcinoma (HCC) lesions and a point-of-care (POC) OMI to assess biopsy cores, all based on tumor retention of ICG compared to normal liver, in phantom and animal model.

MATERIAL

A custom CT image fusion and EM-tracked guidance platform was modified to integrate the measurement of ICG fluorescence intensity signals in targeted liver tissue with an OMI stylet or a POC OMI system. Accuracy was evaluated in phantom and a woodchuck with HCC, 1 day after administration of ICG. Fresh biopsy cores and paraffin-embedded formalin-fixed liver tissue blocks were evaluated with the OMI stylet or POC system to identify ICG fluorescence signal and ICG peak intensity.

RESULTS

The mean distance between the initial guided needle delivery location and the peak ICG signal was 5.0 ± 4.7 mm in the phantom. There was complete agreement between the reviewers of the POC-acquired ICG images, cytology, and histopathology in differentiating HCC-positive from HCC-negative biopsy cores. The peak ICG fluorescence intensity signal in the ex vivo liver blocks was 39 ± 12 and 281 ± 150 for HCC negative and HCC positive, respectively.

CONCLUSION

Biopsy guidance with fused CT imaging, EM tracking, and ICG tracking with an OMI stylet to detect HCC is feasible. Immediate assessment of ICG uptake in biopsy cores with the POC OMI system is feasible and correlates with the presence of HCC in the tissue.

Influence of the Glissonean Pedicle Transection Approach in Spiegel Lobe-Preserving Left Hepatectomy on Spiegel Lobe Volume and Remnant Liver Functions

BACKGROUND

The extrahepatic surgical technique in liver resection can be divided into glissonean pedicle transection and glissonean separated transection approaches. In this study, we compared remnant liver function and liver regeneration involving the Spiegel lobe between these two approaches regarding Spiegel lobe-preserving left hepatectomy.

METHODS

We enrolled 31 patients who underwent Spiegel lobe-preserving left hepatectomy for malignant hepatobiliary diseases between April 2008 and January 2020. The postoperative Spiegel lobe volume was measured using a volume analyzer at 3 and 6 months postoperatively.

RESULTS

Of the 31 patients, 22 and 9 were included in the glissonean separated transection and glissonean pedicle transection groups, respectively. There was no significant between-group difference in the preoperative Spiegel lobe volume. However, the volumes at 3 and 6 months postoperatively were significantly larger in the glissonean pedicle transection group than in the glissonean transection group (29.92 mL vs. 13.00 mL; P < 0.001 and 28.43 mL vs. 15.01 mL; P < 0.001, respectively). There was no significant between-group difference in postoperative remnant liver function.

CONCLUSIONS

The postoperative Spiegel lobe volume was larger, and liver regeneration was better with the glissonean pedicle transection approach because of transection for Spiegel branch of the portal vein. It is desirable to preserve Spiegel branch in possible cases when surgeons select the glissonean separated transection approach based on the location and size of the tumors.

Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition

Background

This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery.

Methods

Thirty-seven patients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed.

Results

Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery.

Conclusion

Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.