Right extended hepatectomy for hilar cholangiocarcinoma: A case report

Radical resection in a case of hilar cholangiocarcinoma is the only curative option. However resection in a hilar cholangiocarcinoma is a challenging procedure because of the low resectability rate. Only a few cases of hilar cholangiocarcinoma are operable because of the advanced nature of disease at presentation. Furthermore, the extent of surgery makes it a complicated process to attempt. We recently had a patient who underwent an open extended right hepatectomy and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma. The tumor was 20 mm in diameter and was located between the right hepatic duct and common hepatic duct. Radiological examination showed that the hepatic artery was not involved but the right portal vein was invaded by the tumor. CT volumetry was done and the future liver remnant was only 20% in the jaundiced patient. Preoperative drainage was done with percutaneous transhepatic biliary drainage from the left side. Portal vein embolization was done to augment future liver remnant to 30%. The patient underwent an extended right hepatectomy (right trisectionectomy combined with caudate lobectomy). The operation time was nearly 300 min, and the intraoperative blood loss was about 500 ml. However, in the postoperative period, the patient developed post hepatic liver failure which was managed successfully with conservative treatment. The postoperative hospital stay was 23 days. The final diagnosis was hilar cholangiocarcinoma with no nodal metastasis (pT2bN0M0) stage II (American Joint Committee on Cancer, AJCC).

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A Comparison of Portal Vein Embolization With Poly(2-hydroxyethylmethacrylate) and a Histoacryl/Lipiodol Mixture in Patients Scheduled for Extended Right Hepatectomy

Physiological Research ◽

10.33549/physiolres.932992 ◽

2015 ◽

pp. 841-848 ◽

Cited By ~ 1

Author(s):

J. H. PEREGRIN ◽

R. JANOUŠEK ◽

D. KAUTZNEROVÁ ◽

M. OLIVERIUS ◽

E. STICOVÁ ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Right Hepatectomy ◽

Portal Vein Branch ◽

Liver Remnant ◽

Extended Right Hepatectomy ◽

The Right ◽

Transhepatic Access ◽

Flr Hypertrophy

ght hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).

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Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Cancers ◽

10.3390/cancers13020200 ◽

2021 ◽

Vol 13 (2) ◽

pp. 200

Author(s):

Salah Khayat ◽

Gianluca Cassese ◽

François Quenet ◽

Christophe Cassinotto ◽

Eric Assenat ◽

...

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Small Sample ◽

Right Hepatectomy ◽

Liver Remnant ◽

Oncological Outcomes ◽

Extended Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

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“Reversal” ALPPS in patient with hepatocellular carcinoma and liver cirrhosis. First clinical case in Russia

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021-3-142-148 ◽

2021 ◽

Vol 26 (3) ◽

pp. 142-148

Author(s):

S. E. Voskanyan ◽

V. S. Rudakov ◽

M. V. Shabalin ◽

A. I. Artemyev ◽

A. N. Bashkov ◽

...

Keyword(s):

Portal Vein ◽

Clinical Case ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Right Hepatectomy ◽

Portal Branch ◽

Liver Remnant ◽

First Case ◽

The Right ◽

Staged Hepatectomy

Liver resection in patients with HCC is the treatment of choice. In patients with insufficient future liver remnant (FLR) and compensated liver function performing the Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is possible. The classic version of ALPPS consists in ligation of the right branch of the portal vein with transection of the parenchyma and then performing right hepatectomy or right trisegmentectomy. This paper describes the first case in Russia of performing ligation of the left portal branch with transection of the parenchyma and then performing left trisegmentectomy (“reversal” ALPPS) in a patient with HCC and cirrhosis. Reversal ALPPS can be successfully performed in patients with insufficient future liver remnant in well-selected patients.

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Comparison of Clinical Outcomes following Glue versus Polyvinyl Alcohol Portal Vein Embolization for Hypertrophy of the Future Liver Remnant prior to Right Hepatectomy

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.05.023 ◽

2016 ◽

Vol 27 (12) ◽

pp. 1897-1905.e1 ◽

Cited By ~ 16

Author(s):

Arash Jaberi ◽

Sundeep S. Toor ◽

Dheeraj K. Rajan ◽

Oleg Mironov ◽

John R. Kachura ◽

...

Keyword(s):

Portal Vein ◽

Polyvinyl Alcohol ◽

Clinical Outcomes ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Right Hepatectomy ◽

Liver Remnant ◽

The Future

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Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000033 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000033

Author(s):

Juan Glinka ◽

Rocio Bruballa ◽

Martin de Santibañes ◽

Rodrigo Sanchez Clariá ◽

Victoria Ardiles ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Portal Vein ◽

Portal Vein Embolization ◽

Pediatric Population ◽

Future Liver Remnant ◽

Liver Parenchyma ◽

Definitive Treatment ◽

Right Hepatectomy ◽

Liver Remnant

BackgroundCommon bile duct injuries (CBDIs) remains a rare but serious complication in children undergoing laparoscopic cholecystectomy (LC), with an incidence of 0.44%. In severe lesions, a major liver resection may be necessary as a definitive treatment. The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection. Therefore, one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant (FLR). To achieve an optimal FLR, techniques such as portal vein embolization (PVE) are available.Case presentationWe present the case of a 5-year-old child with a severe CBDI after LC, treated with preoperative PVE followed by a right hepatectomy as definitive treatment. No reports of liver resections and PVE are described in the literature concerning the pediatric population.

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Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa319 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Carlo Marino ◽

Ignacio Obaid ◽

Gabriela Ochoa ◽

Nicolás Jarufe ◽

Jorge A Martínez ◽

...

Keyword(s):

Hepatic Duct ◽

Open Cholecystectomy ◽

Severe Case ◽

Common Hepatic Duct ◽

Right Hepatectomy ◽

Left Hepatic Lobe ◽

Left Hepatic Duct ◽

Hepatic Lobe ◽

The Right ◽

Vasculobiliary Injury

Abstract Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.

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First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02170-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ming-Gen Hu ◽

Jin Wang ◽

Zhu-Zeng Yin ◽

Rong Liu

Keyword(s):

Portal Vein ◽

Liver Volume ◽

Future Liver Remnant ◽

Falciform Ligament ◽

Remnant Liver ◽

Two Stage ◽

Liver Remnant ◽

Technical Aspects ◽

Estimated Blood Loss ◽

The Right

Abstract Background The associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) procedure is gaining interest because it brings hope to patients who cannot undergo radical surgical resection due to insufficient remnant liver volume. However, the indications and technical aspects of this procedure are still under debate. This report demonstrates the technical aspects of the first two-stage robotic ALPPS for HCC. Case presentation A 55-year-old man with type II portal vein variation was diagnosed with hepatocellular carcinoma. Preoperative 3D reconstruction of the liver based on CT showed a future liver remnant/standard liver volume (FLR/SLV) of 24.45%. The ALPPS procedure was performed using the da Vinci Si system. At the first stage of the operation, we removed the gallbladder and ligated the right anterior branch of the portal vein and the right posterior branch. Following blocking of the hepatic hilum, the liver parenchyma was removed 1 cm away from the right side of the falciform ligament in an incision manner from the top to the bottom and from shallow to deep. The second-stage operation was performed on the 12th postoperative day with a FLR/SLV of 45.13%. During this step, the right hemiliver plus left medial section was separated and removed. Postoperative pathology showed a negative margin. The operative times were 195 and 217 min, respectively. Estimated blood loss was 250 and 500 ml, respectively. There was no need for transfusion or hospitalization in intensive care. The patient was discharged on the 6th postoperative day. Recovery was uneventful after both stages, and the patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. The patient had no evidence of the disease 14 months after the procedure. Conclusions The two-stage robotic ALPPS procedure is a safe and feasible technique for select patients with HCC.

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Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy

Surgical Case Reports ◽

10.1186/s40792-020-01078-3 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yuki Ohya ◽

Shintaro Hayashida ◽

Akira Tsuji ◽

Kunitaka Kuramoto ◽

Hidekatsu Shibata ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Kinase Inhibitor ◽

Sharp Decrease ◽

Hepatic Function ◽

Advanced Hepatocellular Carcinoma ◽

Right Hepatectomy ◽

Advanced Hcc ◽

Extended Right Hepatectomy ◽

The Right

Abstract Background Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive. Case presentation A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year. Conclusion The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.

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