Surgical indications for solid hepatic benign tumors: An updated literature review

Three-dimensional location approach with silk thread guided hepatectomy for liver tumor

BACKGROUND

Intraoperative determination of resection margin and adequate residual liver parenchyma are the key points of hepatectomy for the treatment of liver tumors. Intraoperative ultrasound and indocyanine green fluorescence navigation are the most commonly used methods at present, but the technical barriers limit their promotion.

AIM

To evaluate the value of the three-dimensional location approach with silk thread (3D-LAST) in precise resection of liver tumors.

METHODS

From September 2020 to January 2022, 8 patients with liver tumors including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, hilar cholangiocarcinoma, and gastric cancer liver metastasis were included in this study. All patients underwent 3D-LAST in precise resection of liver tumors.

RESULTS

All patients (8/8, 100%) underwent the operation successfully without any complications. During the mean follow-up of 8.7 months, all patients survived without tumor recurrence.

CONCLUSION

In conclusion, the 3D-LAST is a safe and effective new method for liver intraoperative navigation, which is practical and easy to promote.

Liver transplantation using an otherwise-wasted partial liver resection graft

Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.

Reconsideration of the clinical management of hepatic hemangioma

In this letter, we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery. This article proposes a new clinical grading system based on a multidisciplinary team, which prompts us to rethink the clinical management of hepatic hemangioma. Hepatic hemangioma is the most common benign solid liver tumor. In general, follow-up and observation for the vast majority of hepatic hemangioma is reasonable. For those patients with symptoms and severe complications, surgical intervention is necessary. Specific surgical indications, however, are still not clear. An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma. In this article, we review the recent literature, summarize the surgical indications and treatment of hepatic hemangioma, and evaluate the potential of this new clinical grading system.

Arterial embolization of focal nodular hyperplasia of the liver: A case report

INTRODUCTION AND IMPORTANCE

Focal nodular hyperplasia (FNH) is a benign liver lesion that can pose diagnostic and management dilemmas, especially when distinguishing it from other hypervascular hepatic lesions. The benign nature of FNH often makes conservative management a priority; however, intervention may be necessary in symptomatic cases or when diagnostic uncertainty exists.

CASE PRESENTATION

A 19-year-old male presenting with abdominal pain, found to have a large 25 cm FNH lesion in the right lobe of the liver. Initial diagnosis was achieved through ultrasonography and contrast-enhanced computed tomography (CECT), with histopathological confirmation via core needle biopsy. Given the lesion's size and the patient's symptomatic presentation, we opted for arterial embolization, a less invasive surgical approach, over traditional resection methods. This technique not only led to symptom resolution but also resulted in a significant reduction in lesion size.

CLINICAL DISCUSSION

Our approach to managing this FNH case involved a multidisciplinary team. The decision to employ arterial embolization over more invasive surgical options was based on the lesion's characteristics, the patient's age, and the potential for significant morbidity associated with traditional surgery. Arterial embolization of the FNH lesion resulted in complete resolution of symptoms and a significant reduction in lesion size, from 25 cm to 12 cm, demonstrating the effectiveness of this technique in managing large FNH lesions.

CONCLUSION

Our findings contribute to the scientific literature by showcasing the potential of less invasive surgical techniques in the management of FNH, offering valuable insights for clinicians faced with similar diagnostic and therapeutic challenges.