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Kogure M, Kumon M, Matsuki R, Suzuki Y, Sakamoto Y. Right hemihepatectomy preserving the fluorescently visible paracaval portion of the caudate lobe. Glob Health Med 2023; 5:377-380. [PMID: 38162430 PMCID: PMC10730920 DOI: 10.35772/ghm.2023.01063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/20/2023] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Abstract
The paracaval portion (PC) of the caudate lobe is a small area of the liver located in front of the inferior vena cava. Conventional right hemihepatectomy (RH) along the Rex-Cantlie line involves resection of not only the anterior and posterior sections but also the PC behind the middle hepatic vein (MHV). However, to preserve the future liver remnant volume as much as possible, PC-preserving RH may be beneficial in selected patients. We injected an indocyanine green (ICG) solution in the PC portal branch under intraoperative ultrasonography (IOUS) guidance and performed an RH preserving the fluorescently visible PC in a patient with liver metastasis. The patient was a 47-year-old male with a 24 ×10 cm metastatic hepatic tumor from sigmoid colon cancer. CT volumetry revealed that the left hemiliver excluding the caudate lobe was 55%, and the caudate lobe was 5.3%. Before hepatic transection, the ICG solution was injected into the PC portal branch under IOUS guidance. During hepatic transection, the PC was identified as a fluorescent area behind the MHV using a near-infrared imaging system. Thus, the anatomical right-side boundary of the caudate lobe was clearly found. Following RH, the PC was preserved as a fluorescently visible area. The patient had an uneventful recovery. RH preserving the fluorescently visible PC of the liver is a feasible procedure.
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Affiliation(s)
- Masaharu Kogure
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | | | - Ryota Matsuki
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, Tokyo, Japan
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Hoogteijling TJ, Sijberden JP, Primrose JN, Morrison-Jones V, Modi S, Zimmitti G, Garatti M, Sallemi C, Morone M, Abu Hilal M. Laparoscopic Right Hemihepatectomy after Future Liver Remnant Modulation: A Single Surgeon's Experience. Cancers (Basel) 2023; 15:2851. [PMID: 37345188 DOI: 10.3390/cancers15102851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Laparoscopic right hemihepatectomy (L-RHH) is still considered a technically complex procedure, which should only be performed by experienced surgeons in specialized centers. Future liver remnant modulation (FLRM) strategies, including portal vein embolization (PVE), and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), might increase the surgical difficulty of L-RHH, due to the distortion of hepatic anatomy, periportal inflammation, and fibrosis. Therefore, this study aims to evaluate the safety and feasibility of L-RHH after FLRM, when compared with ex novo L-RHH. METHODS All consecutive right hemihepatectomies performed by a single surgeon in the period between October 2007 and March 2023 were retrospectively analyzed. The patient characteristics and perioperative outcomes of L-RHH after FLRM and ex novo L-RHH were compared. RESULTS A total of 59 patients were included in the analysis, of whom 33 underwent FLRM. Patients undergoing FLRM prior to L-RHH were most often male (93.9% vs. 42.3%, p < 0.001), had an ASA-score >2 (45.5% vs. 9.5%, p = 0.006), and underwent a two-stage hepatectomy (45.5% vs. 3.8% p < 0.001). L-RHH after FLRM was associated with longer operative time (median 360 vs. 300 min, p = 0.008) and Pringle duration (31 vs. 24 min, p = 0.011). Intraoperative blood loss, unfavorable intraoperative incidents, and conversion rates were similar in both groups. There were no significant differences in length of hospital stay and 30-day overall and severe morbidity rates. Radical resection margin (R0) and textbook outcome rates were equal. One patient who underwent an extended RHH in the FLRM group deceased within 90 days of surgery, due to post-hepatectomy liver failure. CONCLUSION L-RHH after FLRM is more technically complex than L-RHH ex novo, as objectified by longer operative time and Pringle duration. Nevertheless, this procedure appears safe and feasible in experienced hands.
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Affiliation(s)
- Tijs J Hoogteijling
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
| | - Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
| | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Victoria Morrison-Jones
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Giuseppe Zimmitti
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
| | - Marco Garatti
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
| | - Claudio Sallemi
- Department of Interventional Radiology, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
| | - Mario Morone
- Department of Interventional Radiology, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Willems E, D'Hondt M, Kingham TP, Fuks D, Choi GH, Syn NL, Sucandy I, Marino MV, Prieto M, Chong CC, Lee JH, Efanov M, Chiow AKH, Choi SH, Sutcliffe RP, Troisi RI, Pratschke J, Cheung TT, Wang X, Tang CN, Liu R, Han HS, Goh BKP. Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score-Matched and Coarsened-Exact-Matched Analysis of 1,100 Patients. J Am Coll Surg 2022; 235:859-868. [PMID: 36102506 PMCID: PMC9720542 DOI: 10.1097/xcs.0000000000000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy. STUDY DESIGN This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed. RESULTS A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching. CONCLUSIONS Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.
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Affiliation(s)
- Edward Willems
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - Mathieu D'Hondt
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY (Kingham)
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France (Fuks)
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Choi)
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore (Syn)
| | - Iswanto Sucandy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Syn)
| | - Marco V Marino
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL (Sucandy)
| | - Mikel Prieto
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy (Marino)
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (Chong)
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Lee)
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia (Efanov)
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore (Chiow)
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (Choi)
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom (Sutcliffe)
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Hepatopancreatobiliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy (Troisi)
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin (Pratschke)
- Berlin Institute of Health, Berlin, Germany (Pratschke)
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Cheung)
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Wang)
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (Tang)
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Liu)
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea (Han)
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore (Goh)
- Duke-National University of Singapore Medical School, Singapore (Goh)
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Rhu J, Choi GS, Kim JM, Kwon CHD, Kim SJ, Joh JW. Laparoscopic right posterior sectionectomy versus laparoscopic right hemihepatectomy for hepatocellular carcinoma in posterior segments: Propensity Score Matching Analysis. Scand J Surg 2018; 108:23-29. [PMID: 29973107 DOI: 10.1177/1457496918783720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS: This study was designed to analyze the feasibility of laparoscopic right posterior sectionectomy compared to laparoscopic right hemihepatectomy in patients with hepatocellular carcinoma located in the posterior segments. MATERIAL AND METHODS: The study included patients who underwent either laparoscopic right posterior sectionectomy or laparoscopic right hemihepatectomy for hepatocellular carcinoma located in segment 6 or 7 from January 2009 to December 2016 at Samsung Medical Center. After 1:1 propensity score matching, patient baseline characteristics and operative and postoperative outcomes were compared between the two groups. Disease-free survival and overall survival were compared using Kaplan-Meier log-rank test. RESULTS: Among 61 patients with laparoscopic right posterior sectionectomy and 37 patients with laparoscopic right hemihepatectomy, 30 patients from each group were analyzed after propensity score matching. After matching, baseline characteristics of the two groups were similar including tumor size (3.4 ± 1.2 cm in laparoscopic right posterior sectionectomy vs 3.7 ± 2.1 cm in laparoscopic right hemihepatectomy, P = 0.483); differences were significant before matching (3.1 ± 1.3 cm in laparoscopic right posterior sectionectomy vs 4.3 ± 2.7 cm in laparoscopic right hemihepatectomy, P = 0.035). No significant differences were observed in operative and postoperative data except for free margin size (1.04 ± 0.71 cm in laparoscopic right posterior sectionectomy vs 2.95 ± 1.75 cm in laparoscopic right hemihepatectomy, P < 0.001). Disease-free survival (5-year survival: 38.0% in laparoscopic right posterior sectionectomy vs 47.0% in laparoscopic right hemihepatectomy, P = 0.510) and overall survival (5-year survival: 92.7% in laparoscopic right posterior sectionectomy vs 89.6% in laparoscopic right hemihepatectomy, P = 0.593) did not differ between the groups based on Kaplan-Meier log-rank test. CONCLUSION: For hepatocellular carcinoma in the posterior segments, laparoscopic right posterior sectionectomy was feasible compared to laparoscopic right hemihepatectomy when performed by experienced laparoscopic surgeons.
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Affiliation(s)
- J Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - G S Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J M Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - C H D Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S J Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J-W Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Li J, Huang J, Wu H, Zeng Y. Laparoscopic living donor right hemihepatectomy with venous outflow reconstruction using cadaveric common iliac artery allograft: Case report and literature review. Medicine (Baltimore) 2017; 96:e6167. [PMID: 28207553 PMCID: PMC5319542 DOI: 10.1097/md.0000000000006167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE With the development of laparoscopic technique, the total laparoscopic living donor right hemihepatectomy (LLDRH) procurement surgery has been successfully performed in many liver transplant centers all over the world, and the number of cases is continuing to increase. We report our case of laparoscopic right graft resection with venous outflow reconstruction using cadaveric common iliac artery allograft in our center and review literatures about total LLDRH surgery. PATIENT CONCERNS AND DIAGNOSES A 40-year-old male living donor for right hepatectomy was selected after pretransplant evaluation including laboratory tests, liver volume, anatomy of hepatic vein, artery, portal vein, and bile duct. Living donor liver transplantation surgery was approved by Sichuan Provincial Health Department and the ethics committee of the West China Hospital, Sichuan University. INTERVENTIONS Hepatic parenchyma transection was performed by ultrasonic scalpel and Cavitron Ultrasonic Surgical Aspirator (CUSA). Right branch of portal vein, right hepatic artery, right hepatic duct, and right hepatic vein were meticulously dissected. The right hepatic duct was ligated and transected 2 mm far from the bifurcation of common hepatic duct, right hepatic artery, and portal vein were also ligated and transected, the right hepatic vein was transected by laparoscopic linear cutting stapler. The gap between short hepatic veins and right hepatic vein was bridged and reconstructed by cadaveric common iliac artery allograft. OUTCOMES The operation time was 480 minutes and warm ischemia time was 4 minutes. Blood loss was 300 mL without blood transfusion. The donor was discharged on postoperative day 7 uneventfully without complications. Literatures about laparoscopic living donor right hemihepatectomy are compared and summarized in table. LESSONS The total laparoscopic living donor right hemihepatectomy is technically feasible and safe in some transplant centers which should have rich open living donor liver transplantation experience and skilled laparoscopic techniques. Venous outflow tract reconstruction is necessary if orifice diameter of short hepatic vein is greater than 0.5 cm on the graft cutting surface.
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