Does extrahepatic hepatic vein control contribute to reduced blood loss in major liver resection?

Massive blood loss remains a problem during resection for giant liver hemangioma. This present study was designed to compare selective hepatic vascular exclusion (SHVE) versus Pringle maneuver in surgery for liver hemangioma compressing the major (right, middle, or left) hepatic veins. From January 2003 to December 2011, 589 consecutive patients with hemangioma underwent liver resection in our department, and 273 patients had their tumors compressing at least one of the three major hepatic veins (right, middle, or left). Either SHVE (n = 120 patients) or Pringle maneuver (n = 153 patients) was used to minimize blood loss during resection. Data regarding the intraoperative and postoperative courses of these patients were retrospectively analyzed. There was no significant difference between the two groups of patients regarding age, sex, tumor size, types of hepatectomy, and extent of tumor involvement of the major hepatic veins. Intraoperative blood loss, transfusion requirements, and transfusion volume were significantly less in the SHVE group ( P < 0.01). For the Pringle group, major hepatic veins were lacerated in 19 patients during hepatic parenchymal transection. For the SHVE group, a major hepatic vein was lacerated during extrahepatic dissection of the hepatic vein in two patients and during hepatic parenchymal transection in 14 patients. SHVE was more efficacious in minimizing intraoperative bleeding during liver resection for hemangiomas compressing the major hepatic veins. It prevented intraoperative major bleeding and air embolism and significantly decreased postoperative liver failure and in-hospital mortality.

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Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report

World Journal of Surgery ◽

10.1007/s00268-017-4016-5 ◽

2017 ◽

Vol 41 (7) ◽

pp. 1848-1856 ◽

Cited By ~ 19

Author(s):

Bertrand Le Roy ◽

Antoine Perrey ◽

Mikael Fontarensky ◽

Johan Gagnière ◽

Armand Abergel ◽

...

Keyword(s):

Liver Resection ◽

Liver Regeneration ◽

Hepatic Vein ◽

Preliminary Report ◽

Major Liver Resection ◽

Hepatic Vein Embolization

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Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BMC Gastroenterology ◽

10.1186/s12876-021-01726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shaohe Wang ◽

Yang Yue ◽

Wenjie Zhang ◽

Qiaoyu Liu ◽

Beicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Caudate Lobe ◽

Postoperative Hospital Stay ◽

Dorsal Approach ◽

Glissonian Approach ◽

The Mean ◽

Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

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A Case of Primary Hepatic Neuroendocrine Tumor and Literature Review

Case Reports in Oncology ◽

10.1159/000510935 ◽

2021 ◽

pp. 90-97

Author(s):

Pak Chiu Wong ◽

Wong Hoi She ◽

Ui Soon Khoo ◽

Tan To Cheung

Keyword(s):

Liver Resection ◽

Neuroendocrine Tumor ◽

Preoperative Diagnosis ◽

Radionuclide Therapy ◽

Tumor Recurrence ◽

Peptide Receptor Radionuclide Therapy ◽

Rare Tumor ◽

Major Liver Resection ◽

Peptide Receptor ◽

Primary Hepatic Neuroendocrine Tumor

We report an unusual presentation of primary hepatic neuroendocrine tumor which was initially misdiagnosed as intrahepatic cholangiocarcinoma. The diagnosis was only revealed after a major liver resection by histopathology. With adjuvant lanreotide injection, the patient survived for more than 16 months after the operation without tumor recurrence. Diagnosis of this rare tumor has been a major challenge and we emphasize the importance of a preoperative diagnosis. Surgical resection remains the mainstay for curative treatment, while peptide receptor radionuclide therapy is an emerging treatment option which has provided promising results.

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