scholarly journals A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

2019 ◽  
Vol 160 (33) ◽  
pp. 1304-1310
Author(s):  
Péter Lukovich ◽  
Balázs Pőcze ◽  
Jenő Nagy ◽  
Tamás Szpiszár ◽  
Alpár György ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Liver Resections ◽  
R1 Resection ◽  
Major Vessel ◽  
Histological Data

Abstract: Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304–1310.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

scholarly journals Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
C. G. Ker ◽  
J. S. Chen ◽  
K. K. Kuo ◽  
S. C. Chuang ◽  
S. J. Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Average Length ◽  
Survival Rates ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Open Approach ◽  
Full Diet ◽  
Or Groups ◽  
Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

scholarly journals Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2281
Author(s):  
Jong Man Kim ◽  
Sangjin Kim ◽  
Jinsoo Rhu ◽  
Gyu-Seong Choi ◽  
Choon Hyuck David Kwon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Elderly Patients ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Transfusion Rate ◽  
Treatment Naïve

It remains unclear whether the short-term benefits and long-term outcomes of laparoscopic liver resection (LLR) accrue to elderly patients with medical comorbidities. The aim of the present study was to compare the outcomes between LLR and open liver resection (OLR) in elderly patients (≥65 years) with solitary, treatment-naïve solitary hepatocellular carcinoma (HCC). From January 2013 to August 2017, 256 elderly patients with solitary treatment-naive HCC underwent liver resection. All patients were Child–Pugh class A and older than 65 years. The OLR and LLR groups contained 160 and 96 patients, respectively. The median tumor size in the OLR group was significantly larger than that in the LLR group (3.9 vs. 2.6 cm), but the tumor size did not differ between the two groups after matching. The median operation time, blood loss, transfusion rate, and postoperative complications in the OLR group did not differ from those in the LLR group, but the operation time in the LLR group was longer than that in the OLR group after matching. The median hospitalization in the LLR group was significantly shorter than that in the OLR group. Disease-free survival (DFS) in the LLR group was better than that in the OLR group before and after matching, but the difference was not significant. Patient survival (PS) in the LLR group was similar to that in the OLR group. LLR is feasible and safe for elderly patients with solitary, treatment-naïve HCC. The short- and long-term benefits of LLR are evident in geriatric oncological liver surgery patients.

Surgical Outcomes of Liver Resection Combined with Inferior Vena Cava Resection and Reconstruction with Artificial Vascular Graft

2018 ◽  
Vol 36 (6) ◽  
pp. 502-508 ◽  
Author(s):  
Yoshito Tomimaru ◽  
Hidetoshi Eguchi ◽  
Hiroshi Wada ◽  
Yuichiro Doki ◽  
Masaki Mori ◽  
...  
Keyword(s):  
Liver Resection ◽  
Inferior Vena Cava ◽  
Surgical Outcomes ◽  
Vascular Graft ◽  
Inferior Vena ◽  
Liver Tumors ◽  
Vena Cava ◽  
Bile Leakage ◽  
Inferior Vena Cava Resection ◽  
Ivc Resection

Background/Aim: Inferior vena cava (IVC) resection and reconstruction with concomitant liver resection sometimes represent the only chance for patients with liver tumors involving the IVC to get cured. However, surgical outcomes of liver resection with IVC resection and reconstruction using an artificial vascular graft have not been well investigated. Methods: Out of a total of 1,179 cases, only 12 involving liver resection between 1998 and 2016 at our institution included IVC resection and reconstruction using an artificial vascular graft. An expanded polytetrafluoroethylene graft was used for the IVC reconstruction in all 12 cases. We investigated the surgical outcomes of these combined surgeries. Results: The median operative time was 650 min and the median blood loss was 2,600 mL. Postoperative complications (≥ grade III in the Clavien-Dindo classification) developed in 2 patients – 1 case of bleeding and one of bile leakage. There were no cases of operative mortality. No complications associated with the vascular graft were observed throughout the postoperative follow-up period, and the grafts remained patent in all cases. Conclusions: These results indicate favorable surgical outcomes of liver resection combined with IVC resection and reconstruction.

scholarly journals Integrative Concepts for Liver Surgery

2020 ◽  
Vol 36 (5) ◽  
pp. 351-358
Author(s):  
Stefan Heinrich ◽  
Felix Watzka ◽  
Hauke Lang
Keyword(s):  
Liver Transplantation ◽  
Patient Selection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Treatment Options ◽  
Molecular Characteristics ◽  
Primary Tumors ◽  
Primary Liver Tumors ◽  
Liver Resections ◽  
Systemic Treatments

<b><i>Background:</i></b> Surgery is the standard treatment for primary tumors and metastases. Due to improvements in surgical outcomes as well as the efficacy of systemic treatments, the role of surgery has changed in recent years. <b><i>Summary:</i></b> Liver surgery has become safe and efficient, with resectability being increased by multimodality concepts as well as staged liver resections and orthotopic liver transplantation. These concepts may be applied to primary liver tumors but also to selected patients with liver metastases from various diseases. In addition, even debulking surgery may be indicated for selected patients with endocrine metastases. While patient selection for liver resections was limited to clinical parameters in the past, histological and molecular characteristics have become increasingly important. Moreover, the response to regional or systemic chemotherapy has been demonstrated to be strong for a beneficial course of the disease even in advanced diseases. <b><i>Key-Messages:</i></b> Due to the variety of available treatment options, optimal patient selection is crucial. Besides liver surgery, staged concepts as well as liver transplantation are curative tools for many patients.

Innovative Surgical Approaches for Locally Advanced Hepatic Malignancy

2020 ◽  
Vol 04 (01) ◽  
pp. 046-052
Author(s):  
Young-Dong Yu ◽  
Dong-Sik Kim
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Portal Vein Ligation ◽  
Hepatic Malignancy ◽  
Term Survival ◽  
Advanced Malignancy

AbstractPrimary and secondary liver tumors are among the most common tumors in humans. Liver resection and liver transplantation are used to treat these malignancies. However, in many patients with locally advanced malignancy, it is not possible to resect these tumors using conventional techniques due to their enormous size or complex location. Refinements of surgical techniques have led to great improvements in terms of postoperative outcome and long-term survival in the past decades. This review explores innovative technologies in liver surgery, including both resection and transplantation, and their potential role in treating locally advanced hepatic malignancy. A number of innovative surgical techniques such as associating liver partition and portal vein ligation for liver surgery (ALPPS), ex vivo resection, ante situm liver resection, liver resection using extracorporeal hepatic venous bypass, and resection and partial liver segment 2/3 transplantation with delayed total hepatectomy (RAPID) have been developed to overcome the barriers of conventional liver resection and may offer acceptable outcomes for well-selected patients with locally invasive tumors that are otherwise inoperable by conventional techniques.

scholarly journals Сomparative analysis of perioperative results of laparoscopic and open liver resections for hepatocellular carcinoma

2020 ◽  
Vol 25 (2) ◽  
pp. 49-54
Author(s):  
R. B. Alikhanov ◽  
M. G. Efanov ◽  
V. V. Tsvirkun ◽  
A. N. Vankovich ◽  
I. V. Kazakov ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Liver Resection ◽  
Hospital Stay ◽  
Varicose Veins ◽  
Perioperative Complications ◽  
Operation Time ◽  
Early Postoperative Period ◽  
Liver Resections ◽  
Class B

Aim: comparative analysis of peri-operative results of laparoscopic and open liver resections for hepatocellular carcinoma.Matherial and methods. A retrospective analysis included 73 patients with hepatocellular carcinoma who underwent liver resection from 2014 to 2019. In patients with liver cirrhosis contraindications were: 2 degree of varicose veins of eosophagus, severe ascites, liver cirrhosis class B and C (Child–Pugh)Results. Average operation time in comparing groups did not differ. Bloodloss (502 ml and 1380 ml), frequancy of complications by Clavien–Dindo (32.6% and 55.5%), duration of post-operative hospital stay (8 days and 13,6 days) were significantly less in the group of patients with laparoscopic liver resection (р < 0.05). In the early postoperative period, 2 (2.7%) patients died due to sepsis and posthepatectomy liver failure. There were no fatal outcomes in the group of laparoscopic liver resections.Conclusion. Laparoscopic liver resections for hepatocellular carcinoma has advantages in terms of prevention intraoperative bloodloss, and allow to reduce perioperative complications and post-operative hospital stay. This is important for rapid recovery of patients and for prompt ongoing of complex treatment.

Hospitalization Costs and Outcomes of Open, Laparoscopic, and Robotic Liver Resections

2021 ◽  
pp. 000313482110110
Author(s):  
Hassan Aziz ◽  
Kamil Hanna ◽  
Nassim Lashkari ◽  
Noor-Us-Sabah Ahmad ◽  
Yuri Genyk ◽  
...  
Keyword(s):  
Liver Resection ◽  
Laparoscopic Approach ◽  
Cost Effective ◽  
The United States ◽  
Hospital Length Of Stay ◽  
Financial Benefit ◽  
Readmission Rates ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
Hospitalization Costs

Introduction Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach. Methods We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs. Results 3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission. Conclusions There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost.

scholarly journals Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?

2020 ◽  
Author(s):  
Bhavin B Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Liver Resection ◽  
Blood Loss ◽  
Operative Time ◽  
Liver Tumors ◽  
Chi Square ◽  
Donor Hepatectomy ◽  
Statistical Significant Difference ◽  
Liver Resections ◽  
Significant Difference

AbstractBackgroundWe evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy.Material and MethodWe use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246.ResultsWe evaluated 26 liver resections done in last three years. 19 liver resections were done using extrafascial transfissural approach for various liver tumors and 7 living donor hepatectomies were done using itrafascial technique with clamp crush methods. Mean age of patients was 50.73 years.16 patients were males and 10 were females. Mean blood loss was 273.9 ml and mean operative duration was 184.7 minutes. 22 were major resections, 4 were minor liver resections. All minor liver resections were in transfissural approach however there was no statistical significant difference between them. Being live liver doners patients in intrafacial group they were younger than extrafascial transfissural group. (p=0.01). There was no statistical significant difference in blood loss, blood products requirements, morbidity, in hospital and 90 days mortality in both the groups. However extrafascial transfissural with finger fracture technique was associated with significant less operative time. (168.13 minutes vs 222.86 minutes) (p=0.006). 90 days mortality was associated with higher ASA grade (0.018) and blood loss (0.008). However in multivariate analysis no factor indepedently predicted mortality.ConclusionExtrafascial transfissural approach significantly reduces operative time, without affecting morbidity and mortality in liver resection.

scholarly journals Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer

2021 ◽  
Vol 5 (2) ◽  
pp. 14-16
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Liver Resection ◽  
Inferior Vena Cava ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Liver Tumors ◽  
Vena Cava ◽  
Diagnostic Methods ◽  
Donor Organ ◽  
Surgical Interventions ◽  
Medical Specialists

Invasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients.

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