scholarly journals Segment-oriented liver resections based on posterior intrahepatic glissonian approach

2012 ◽  
Vol 59 (3) ◽  
pp. 41-48 ◽  
Author(s):  
Krstina Doklestic ◽  
Vladimir Djukic ◽  
Vesna Bumbasirevic ◽  
Bojan Jovanovic ◽  
Aleksandar Karamarkovic
Keyword(s):  
Liver Tumors ◽  
Vascular Occlusion ◽  
Liver Parenchyma ◽  
R0 Resection ◽  
Liver Resections ◽  
Glissonian Approach ◽  
Glissonean Pedicle ◽  
Tumor Clearance ◽  
Parenchyma Sparing ◽  
Vascular Stapler

Background: Segment-oriented liver resections can be performed effective by posterior intrahepatic approach. A significance of such resection is that they are oncologically radical as well as parenchyma- sparing. Methodology: Segmental liver resections were performed in 102 patients with liver tumors. Suprahilar control of the appropriate glissonean pedicle was achieved by the posterior intrahepatic approach. Liver parenchyma was transsected by ultrasonic dissector, under intermittent vascular occlusion (IVO). Pedicle was divided at the end of resection using "endo-GIA" vascular stapler. Results: The overall transection time was 30,14+12,56 min. The amount of blood loss was 285,59+129,92 ml. The postoperative complication rate was 25,49%. R0 resection had 94 (92,16%) patients. There was no liver failure or perioperative death. Conclusions: Posterior intrahepatic approach for segmental resection is safe, can expedite the liver transection and reduce intraoperative hemorrhage. This approach provides adequate tumor clearance with preservation of normal parenchyma, as well as the vasculature or the biliary drainage of the contralateral liver.

scholarly journals Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery

2021 ◽  
Vol 10 (22) ◽  
pp. 5265
Author(s):  
Aristotelis Perrakis ◽  
Mirhasan Rahimli ◽  
Andrew A. Gumbs ◽  
Victor Negrini ◽  
Mihailo Andric ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Liver Parenchyma ◽  
R0 Resection ◽  
Parenchymal Transection ◽  
Minimally Invasive Liver Surgery ◽  
Robotic Hepatectomy ◽  
Liver Resections ◽  
New Strategy ◽  
Laparoscopic Techniques ◽  
Robotic Liver Surgery

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience. Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS). Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections (p < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections (p = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases. Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.

Eight years after introducing liver resection at the Oncology Institute of Vojvodina

2013 ◽  
Vol 21 (3-4) ◽  
pp. 101-104
Author(s):  
Ivan Majdevac ◽  
Nikola Budisin ◽  
Milan Ranisavljevic ◽  
Dejan Lukic ◽  
Imre Lovas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Tumors ◽  
Liver Parenchyma ◽  
Malignant Neoplasms ◽  
Chemotherapy Treatment ◽  
Primary Liver Tumors ◽  
Cancer Metastases ◽  
Colorectal Cancer Metastases ◽  
Medical Histories

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

Feasibility of Nonanatomical Liver Resection in Diligently Selected Patients with Hepatoblastoma and Comparison of Outcomes with Anatomic Resection

2020 ◽  
Author(s):  
Sajid S. Qureshi ◽  
Seema A. Kembhavi ◽  
Mufaddal Kazi ◽  
Vasundhara Smriti ◽  
Akshay Baheti ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Treatment Guidelines ◽  
Liver Tumors ◽  
Oncologic Outcomes ◽  
Resection Margins ◽  
Liver Resections ◽  
Significant Difference ◽  
Group Distribution

Abstract Introduction Treatment guidelines for hepatoblastoma discourage nonanatomic liver resections. However, the evidence for this is inadequate and comes from a study performed almost two decades ago which additionally contained inherent limitations. This study aimed to assess the feasibility and oncologic outcomes of nonanatomic resections (NAR) performed in diligently selected patients and compare the results with anatomic resections (AR). Materials and Methods A total of 120 patients who underwent liver resections for hepatoblastoma between January 2008 and July 2019 were reviewed. Feasibility of NAR was based on postchemotherapy relations to vessels, site of the lesion, and possibility of achieving negative resection margins. Results AR was performed in 95 patients and 25 had NAR. The NAR cohort had similar International Childhood Liver Tumors Strategy Group (SIOPEL) risk group distribution. Blood loss and operative times were lower in patients undergoing NAR. No differences were noted between the two groups concerning postoperative morbidity and hospitalization. There were no pathologic positive margins or local recurrences in the NAR patients. Relapse free (RFS) and overall survival (OS) was similar in the two groups (p = 0.54 and 0.96, respectively). Subgroup analysis of only posttreatment extent of tumor (POSTTEXT) I and II patients also showed no difference in RFS or OS for the two groups with a persistent significant difference in operative times and blood loss. Conclusion NAR is feasible with clear margins in carefully selected patients. It is not associated with more complications and outcomes are not inferior to AR. NAR is associated with lesser blood loss and operative time.

Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion

2009 ◽  
Author(s):  
Kurinchi Selvan Gurusamy ◽  
Yogesh Kumar ◽  
Viniyendra Pamecha ◽  
Dinesh Sharma ◽  
Brian R Davidson
Keyword(s):  
Vascular Occlusion ◽  
Liver Resections

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.

Identification of new liver tumor biomarkers using proteomics.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21091-e21091
Author(s):  
Peter J. Maimonis ◽  
Yoh Zen ◽  
David J. Britton ◽  
Andrew Brand ◽  
Malcolm Ward ◽  
...  
Keyword(s):  
Liver Tumor ◽  
Liver Tumors ◽  
Early Stage ◽  
Normal Liver ◽  
Liver Parenchyma ◽  
Tissue Type ◽  
P Value ◽  
Tumor Biomarkers ◽  
Formalin Fixed Paraffin Embedded ◽  
New Biomarkers

e21091 Background: It is crucial to identify new biomarkers that help diagnose cancers at an early stage and contribute to the development of new anti-cancer drugs. Here, we identify new liver tumor biomarkers using proteomics. Methods: We evaluated 9 types of liver tissue from 55 patients: normal liver parenchyma (n=7), hepatocellular carcinoma (HCC) (n=7), normal bile duct (n=6), peripheral cholangiocarcinoma (CC) (n=7), hilar CC (n=7), CC associated with primary sclerosing cholangitis (PSC) (n=7), metastatic colorectal cancer (n=7), and mixed HCC/CC after trans-arterial chemoembolization (n=7; areas of HCC and areas of CC separately examined). Protein extracted from microdissected, formalin-fixed paraffin-embedded tissue (0.15 mm3 in total) was reduced, alkylated and digested with trypsin in a stacking gel. Peptides were analyzed using nano-liquid chromatography-Mass spectrometry. The raw data were searched using Mascot. Normalized spectral counts for each protein among each tissue type were compared. For each comparison, an unrelated t-test was computed to obtain the p value. q values (adjusted p values) were computed using a direct False Discovery Rate approach (q < 0.05 considered statistically significant). Results: The mean number of proteins identified per sample was 762 +/- 119 S.D, resulting in a total of 2643 proteins identified. Numbers of proteins with significantly different expression levels among different tissue types are shown below. Some of these proteins are being reported here for the first time in the context of liver carcinogenesis. Conclusions: This study revealed proteins that are significantly over/underexpressed in particular types of liver tumors. Clinically useful new biomarkers may be present among these proteins and are now undergoing validation using immunohistochemisty. [Table: see text]

R0 Liver Resections for Primary Malignant Liver Tumors in the Noncirrhotic Liver: A Diagnosis-Related Analysis

2008 ◽  
Vol 54 (4) ◽  
pp. 887-894 ◽  
Author(s):  
Georgios C. Sotiropoulos ◽  
Maximilian Bockhorn ◽  
George Sgourakis ◽  
Eirini I. Brokalaki ◽  
Ernesto P. Molmenti ◽  
...  
Keyword(s):  
Liver Tumors ◽  
Liver Resections ◽  
Noncirrhotic Liver ◽  
Malignant Liver Tumors ◽  
Malignant Liver

scholarly journals Ex vivo liver resection for liver tumors: Last resort when conventional technique is not applicable

2021 ◽  
Vol 10 (2) ◽  
pp. 06-09
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Liver Resection ◽  
Liver Tumors ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Conventional Technique ◽  
Ex Situ ◽  
R0 Resection ◽  
Anatomical Site ◽  
Hepatic Neoplasms ◽  
Complications Rate

1. Purpose: The treatment of hepatic neoplasms has undergone, in recent years, various evolution of the surgical technique and extension to the indication for resection. Many patients with liver tumors cannot benefit from resection due to the difficulty of the anatomical site of the lesion.Of these patients, only some can benefit from ex vivo hepatic resection, which consists of a complete hepatectomy, bench tumor resection and self-transplant. 2. Materials and methods: We have retrospectively evaluated PUBMED databases. Studies was evaluated from 2010 to 2020.Only very few studies analyzed “Ex situ liver resection”, “Extracorporeal liver resection”, “Liver auto-transplantation”. Conclusion: Ex vivo liver resection and autotransplantation is fesible in very few patients with unresectable hepatic tumor fit for surgery. R0 resection accounts about 60%-90% but outcomes are less satisfactory due to high complications rate of about 25% and low survival in 3 years.

scholarly journals Liver Resections for Metastasis: Surgical Outcomes of a Single Center Academic Institution

2020 ◽  
Author(s):  
Phillipe Abreu ◽  
Raphaella Ferreira ◽  
Danilo Saavedra Bussyguin ◽  
Eduardo Da Cás ◽  
Vighnesh Vetrivel Venkatasamy ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Liver Tumors ◽  
Reoperation Rate ◽  
Categorical Variables ◽  
Morbidity Rate ◽  
Surgical Morbidity ◽  
Chi Square ◽  
Liver Resections ◽  
Institutional Review ◽  
Chi Square Test

Abstract Background:Hepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications. Methods:This retrospective comparative descriptive study aims to evaluate a series of 86 consecutive liver resections (LRs) performed for the treatment of metastatic liver tumors, comparing the results between patients undergoing major and minor LR. All patients submitted to LR from October 2010 to July 2015 at the Erasto Gaertner Hospital in Curitiba-PR were included. Quantitative numerical variables were analyzed with the Student t-test. The nonparametric Mann-Whitney U test was used for numerical variables of non-normal distribution. Categorical variables were analyzed with the Chi-square test with Fisher's correction. The data were analyzed with the SPSS 23.0 and STATA 15 programs, being p<0.05 considered statistically significant. Results:Eighty-sixLR were performed, 56 cases by colorectal metastasis. The major LR corresponded to 68 cases, with 13.2% of Clavien-Dindo III-V complications and 2.9% of reoperation rate. Eighteen minor LR were performed and one patient had a postoperative complication requiring reoperation. Conclusion: Preoperative elevation of transaminases and jaundice negatively influence surgical outcomes in patients undergoing LR. Tumors greater than 3 cm presented worse postoperative survival. Major LR did not significantly increase the surgical morbidity rate.Institutional Review Board registration:1.122.319/2015

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