scholarly journals Isolated Caudate Lobectomy: Glissonean Pedicle Transection Method, and Combined Right–left Side Approach. A Case Series Report

2021 ◽  
Author(s):  
Luong Hiep
Keyword(s):  
Complex Structure ◽  
Liver Volume ◽  
Vena Cava ◽  
Case Series ◽  
Caudate Lobe ◽  
Benign Tumors ◽  
Remnant Liver ◽  
Caudate Lobectomy ◽  
Primary Tumors ◽  
Glissonean Pedicle

Abstract Tumors located in caudate lobe may be primary tumors, or metastases from other sites. Isolated caudate lobectomy (ICL) is a challenging procedure due to its complex structure and location. The access route to caudatelobe has an important role in the success of the operation. A combined right and left side approach is recommended for benign or suspected malignant tumor located anterior to the vena cava or entirely in the caudate lobe, which radical resection of the caudate is necessary. We report two cases of successfully with Glissonean pedicle transection method described by Takasaki and combined right and left side approach. We found this to be a safe and effective approach, which can be applied to all case of benign tumors; or in the case of malignant tumors located entirely in the caudate lobe when extended hepatic resection is not possible due to poor liver function. or small remnant liver volume.

Imaging Features of Primary Tumors of the Hand

2020 ◽  
Vol 16 ◽  
Author(s):  
Filippo Boriani ◽  
Edoardo Raposio ◽  
Costantino Errani
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Epithelioid Sarcoma ◽  
Case Series ◽  
Malignant Neoplasm ◽  
Benign Tumors ◽  
Imaging Features ◽  
Primary Tumors ◽  
Therapeutic Decisions ◽  
Tumors Of The Hand

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

scholarly journals Right hepatectomy with preservation of the entire caudate lobe in patients with metastatic liver tumors: a case of a new hepatectomy technique and treatment strategy for patients with marginal liver function

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroyuki Kato ◽  
Yukio Asano ◽  
Masahiro Ito ◽  
Satoshi Arakawa ◽  
Norihiko Kawabe ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Indocyanine Green ◽  
Liver Volume ◽  
Caudate Lobe ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Indocyanine Green Clearance ◽  
The Right ◽  
Metastatic Liver

Abstract Background Performing major hepatectomy for patients with marginal hepatic function is challenging. In some cases, the procedure is contraindicated owing to the threat of postoperative liver failure. In this case report, we present the first case of marginal liver function (indocyanine green clearance retention rate at 15 min [ICGR15]: 28%) successfully treated with right hepatectomy, resulting in total caudate lobe preservation. Case presentation A 71-year-old man was diagnosed with sigmoid colon cancer with three liver metastases (S5, S7, and S8). All of metastatic lesions shrunk after chemotherapy, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12, respectively. Moreover, the remnant liver volume was only 39%. Therefore, portal venous embolism (PVE) of the right portal vein was suggested. Portography showed divergence of the considerably preserved right caudate lobe branch (PV1R) from the root of the right portal vein. The liver function was reevaluated 18 days after PVE was suggested. During this time, the ICGR15 (21–28%) and ICGK rate (0.12–0.10) deteriorated. The right caudate lobe was significantly enlarged; thus, a total caudate lobe-preserving hepatectomy (TCPRx) was performed. Patients eligible for TCPRx included those with (1) hepatocellular carcinoma or metastatic liver cancer, (2) no tumor in the caudate lobe, (3) marginal liver function (ICG Krem greater than 0.05 if TCPRx was adapted; otherwise, less than 0.05) and Child–Pugh classification category A, and (4) preserved PV1R and right caudate bile duct branch. The procedure was performed through (A) precise estimation of the remnant liver volume preoperatively, (B) repeated intraoperative cholangiography to confirm the biliary branch of the right caudate lobe (B1R) conservation, and (C) stapler division of posterior and anterior Glisson’s pedicles laterally to avoid injuries to the PV1R and B1R. Conclusions Right hepatectomy with total caudate lobe preservation, following PVE, was a safe and viable surgical technique for patients with marginal liver function.

scholarly journals A case of caudate lobe metastasis of colon cancer resected by total caudate lobectomy combined with partial resection of inferior vena CAVA.

1989 ◽  
Vol 22 (11) ◽  
pp. 2732-2735 ◽  
Author(s):  
Masato NAGINO ◽  
Naokazu HAYAKAWA ◽  
Mituru DOHKE ◽  
Shigehisa KITAGAWA ◽  
Yuji NIMURA ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Caudate Lobe ◽  
Partial Resection ◽  
Caudate Lobectomy

scholarly journals Isolated Resection of Segment I (Caudate Lobe): Is it Justified?

HPB Surgery ◽  
1996 ◽  
Vol 10 (2) ◽  
pp. 121-123 ◽  
Author(s):  
Leslie H. Blumgart
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hemodynamic Instability ◽  
Caudate Lobe ◽  
Hepatic Veins ◽  
Caudate Lobectomy ◽  
Clockwise Rotation ◽  
Venovenous Bypass ◽  
Pringle’S Maneuver

Background: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed.Methods: Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularised by Pringle's maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava.Results: Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction.Conclusions: This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.

scholarly journals Surgical Strategy for Isolated Caudate Lobectomy: Experience with 16 Cases

HPB Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Gendong Tian ◽  
Qiong Chen ◽  
Yuan Guo ◽  
Mujian Teng ◽  
Jie Li
Keyword(s):  
Inferior Vena Cava ◽  
Surgical Procedure ◽  
Inferior Vena ◽  
Vena Cava ◽  
Caudate Lobe ◽  
Surgical Strategy ◽  
Caudate Lobectomy ◽  
Surgical Experience ◽  
Hepatic Parenchyma ◽  
Left And Right

Introduction. Surgical resection is the most effective treatment for neoplasm in the caudate lobe. Isolated caudate lobectomy is still a challenge for hepatobiliary surgeons. No widely accepted surgical strategy for the procedure has been developed yet. Objective. To get a better understanding of isolated caudate lobectomy and to optimize the procedure. Materials and Methods. 16 cases of isolated caudate lobectomy were reviewed to summarize the surgical experience. Results. All the 16 cases of isolated caudate lobectomy were carried out successfully, among which left side approach was adopted in two cases (12.5%), right side approach in three cases (18.75%), and both sides approach in 11 cases (68.75%). No severe complications occurred. Conclusion. The majority of neoplasms confined to the caudate lobe can be resected safely by left and right side approach with proper anatomic surgical procedure, usually in the sequence of mobilization, outflow control, inflow control, and division of the hepatic parenchyma. Fully mobilizing the caudate lobe from the inferior vena cava (IVC) is of great importance. Division of the retrohepatic ligament and the venous ligament facilitated the procedure.

Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Liver Metastasis ◽  
Colorectal Liver Metastasis ◽  
Surgical Intervention ◽  
Liver Volume ◽  
Sigmoid Colon Cancer ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Right ◽  
Synchronous Colorectal Liver Metastasis ◽  
Right Hepatic Vein

A 72-year-old woman with a sigmoid colon cancer anda synchronous colorectal liver metastasis (CRLM), whichinvolved the right hepatic vein (RHV) and the inferiorvena cava (IVC), was referred to our hospital. Themetastatic lesion was diagnosed as initially unresectablebecause of its invasion into the confluence of theRHV and IVC. After she had undergone laparoscopicsigmoidectomy for the original tumor, she consequentlyhad 3 courses of modified 5-fluorouracil, leucovorin,and oxaliplatin (mFOLFOX6) plus cetuximab. Computedtomography revealed a partial response, and theconfluence of the RHV and IVC got free from cancerinvasion. After 3 additional courses of mFOLFOX6 pluscetuximab, preoperative percutaneous transhepaticportal vein embolization (PTPE) was performed tosecure the future remnant liver volume. Finally, a righthemihepatectomy was performed. The postoperativecourse was uneventful. The patient was dischargedfrom the hospital on postoperative day 13. She hadneither local recurrence nor distant metastasis 18 moafter the last surgical intervention. This multidisciplinarystrategy, consisting of conversion chemotherapy usingFOLFOX plus cetuximab and PTPE, could contributein facilitating curative hepatic resection for initiallyunresectable CRLM.Key words: Initially unresectable; Colorectal liver metastasis;Conversion chemotherapy; Cetuximab; Percutaneoustranshepatic portal vein embolization

scholarly journals Laparoscopic isolated caudate lobe resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maulik Parikh ◽  
Ho-Seong Han ◽  
Jai Young Cho ◽  
Mizelle D’Silva
Keyword(s):  
Survival Rate ◽  
Disease Free Survival ◽  
Operation Time ◽  
Caudate Lobe ◽  
Open Group ◽  
Caudate Lobectomy ◽  
Technological Advances ◽  
Estimated Blood Loss ◽  
Hospital Patients ◽  
National University

AbstractPreviously, isolated caudate lobectomy was rarely performed and the caudate lobe was usually resected along with other segments. Isolated caudate lobe resection is a challenging procedure even for an experienced surgeon. Our aim was to evaluate the feasibility, safety and outcomes of laparoscopic isolated caudate lobectomy and to compare these with the open technique. We retrospectively analyzed 21 patients who underwent isolated caudate lobectomy between January 2005 and December 2018 at Seoul National University Bundang Hospital. Patients who underwent either anatomical or non-anatomical resection of the caudate lobe were included. Patients were divided into two groups according to whether they underwent laparoscopic or open surgery. Intra-operative and postoperative outcomes were compared with a median follow-up of 43 months (4–149). A total of 21 patients were included in the study. Of these, 12 (57.14%) underwent laparoscopic and nine (42.85%) underwent open caudate lobectomy. Median operation time (204.5 vs. 200 minutes, p = 0.397), estimated blood loss (250 vs. 400 ml, p = 0.214) and hospital stay (4 vs. 7 days, p = 0.298) were comparable between laparoscopy and open group. The overall post operative complication rate was similar in both groups (p = 0.375). The 5-year disease free survival rate (42.9% vs 60.0%, p = 0.700) and the 5-year overall survival rate (76.2% vs 64.8%, p = 0.145) was similar between laparoscopy and open group. Our findings demonstrate that with increasing surgical expertise and technological advances, laparoscopic isolated caudate lobectomy can become a feasible and safe in selected patients.

scholarly journals Prognostic Value of Liver and Spleen Stiffness in Patients with Fontan Associated Liver Disease (FALD): A Case Series with Histopathologic Comparison

2021 ◽  
Vol 8 (3) ◽  
pp. 30
Author(s):  
Massimo Padalino ◽  
Liliana Chemello ◽  
Luisa Cavalletto ◽  
Annalisa Angelini ◽  
Marny Fedrigo
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Prognostic Value ◽  
Fontan Operation ◽  
Vena Cava ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Post Mortem ◽  
Spleen Stiffness

The Fontan operation is the current surgical procedure to treat single-ventricle congenital heart disease, by splitting the systemic and pulmonary circulations and thus permitting lifespan to adulthood for the majority of newborns. However, emerging data are showing that Fontan-associated liver disease (FALD) is an increasing related cause of morbidity and mortality in patients with the Fontan circuit. We described the clinical, laboratory, and transient elastography (TE) findings in a case series of adults with the Fontan circuit, and also correlated data with post-mortem histological features, aimed to define the prognostic value of TE in the staging of FALD. All patients presented signs of a long-standing Fontan failure, characterized by reoperation need, systemic ventricle dysfunction, and FALD stigmata (liver and spleen enlargement, portal vein and inferior vena cava dilation, and abnormal liver function tests). Liver and spleen stiffness (LS and SS) values were indicative of significant liver fibrosis/cirrhosis and the presence of suggestive portal hypertension (LS mean 35.9; range 27.3–44.7 kPa; SS mean 42.1, range 32.2–54.5 kPa). Post-mortem evaluations confirmed a gross hepatic architecture distortion in all cases. All patients died from severe complications related to liver dysfunction and bleeding. TE correlated well with pathological findings and FALD severity. We propose this validated and harmless technique to monitor liver fibrosis extension and portal hypertension over time in Fontan patients, and to identify the optimal timing for surgical reoperations or orthotopic-heart transplantation (OHT), avoiding a higher risk of morbidity and mortality in cases with severe FALD.

scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

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