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BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroyuki Kato ◽  
Yukio Asano ◽  
Masahiro Ito ◽  
Satoshi Arakawa ◽  
Norihiko Kawabe ◽  
...  

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.


2021 ◽  
Author(s):  
Muhammad Naeem ◽  
Marcello Ricardo Paulista Markus ◽  
Mohammed Mousa ◽  
Sabine Schipf ◽  
Marcus Dörr ◽  
...  

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261094
Author(s):  
Kohei Harada ◽  
Tomohiro Ishinuki ◽  
Yoshiya Ohashi ◽  
Takeo Tanaka ◽  
Ayaka Chiba ◽  
...  

Although the liver is a regenerating organ, excessive loss of liver volume (LV) can cause fatal liver failure. It is unclear whether LV is correlated with age; however, it is known that liver function decreases with age. In addition, the gender-related role of LV remains unclear. This study aimed to investigate the changes in LV by age and gender. Between January and December 2018, 374 consecutive patients who underwent abdominal multidetector computed tomography (MDCT) for any abdominal examinations were enrolled. LV was evaluated using MDCT. The relationship between the LV and body mass index (BMI), body surface area (BSA), age, and gender was investigated. The modified LV (mLV) was calculated by a formula measured LV × 1.5/BSA. LV correlated to BSA more than to BMI in both the males (R: 0.559 vs. 0.416) and females (R: 0.479 vs. 0.300) in our study. Age was negatively correlated to LV and BSA, and correlated to LV more than to BSA in males (R: 0.546 vs. 0.393) and females (R: 0.506 vs. 0.385). In addition, the absolute slope between age and LV in the males was higher than that in the females (14.1 vs. 10.2, respectively). Furthermore, the absolute slope of age and mLV in the males was slightly higher than in the females (9.1 vs. 7.3, respectively). In conclusion, LV in the normal liver is correlated to age rather than the one in the diseased liver. Liver volume in the males decreased more with age than LV in the females.


2021 ◽  
Author(s):  
Sara L. Saunders ◽  
Justin M. Clark ◽  
Kyle Rudser ◽  
Anil Chauhan ◽  
Justin R. Ryder ◽  
...  

AbstractPurposeTo determine which types of magnetic resonance images give the best performance when used to train convolutional neural networks for liver segmentation and volumetry.MethodsAbdominal MRI scans were performed on 42 adolescents with obesity. Scans included Dixon imaging (giving water, fat, and T2* images) and low-resolution T2-weighted anatomical scans. Multiple convolutional neural network models using a 3D U-Net architecture were trained with different input images. Whole-liver manual segmentations were used for reference.Segmentation performance was measured using the Dice similarity coefficient (DSC) and 95% Hausdorff distance. Liver volume accuracy was evaluated using bias, precision, and normalized root mean square error (NRMSE).ResultsThe models trained using both water and fat images performed best, giving DSC = 0.94 and NRMSE = 4.2%. Models trained without the water image as input all performed worse, including in participants with elevated liver fat. Models using the T2-weighted anatomical images underperformed the Dixon-based models, but provided acceptable performance (DSC ≥ 0.92, NMRSE ≤ 6.6%) for use in longitudinal pediatric obesity interventions.ConclusionThe model using Dixon water and fat images as input gave the best performance, with results comparable to inter-reader variability and state-of-the-art methods.


2021 ◽  
Vol 11 ◽  
Author(s):  
Davide Scafa ◽  
Thomas Muedder ◽  
Jasmin A. Holz ◽  
David Koch ◽  
Younéss Nour ◽  
...  

Purpose/ObjectivesTo perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases.Methods/MaterialsDiagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities.ResultsEight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm3 (SD, 650.82), and the mean GTV volume was 12.23 cm3 (SD, 12.62). As for target structures, GTV-IORT [19.44 cm3 (SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm3 (SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm3 (SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5–4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V9.1 showed significantly smaller volumes with IORT [63.39 cm3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm3 (SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D90 was 85.3% (SD, 6.05), whereas D95 for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively.ConclusionKilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.


Author(s):  
Adam M. Lubert ◽  
Alexander R. Opotowsky ◽  
Joseph J. Palermo ◽  
Tarek Alsaied ◽  
Cassandra Szugye ◽  
...  

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Carlo Garofalo ◽  
Ivana Capuano ◽  
Luigi Pennino ◽  
Ilaria De Gregorio ◽  
Eleonora Riccio ◽  
...  

AbstractA clear evidence on the benefits of somatostatin analogues (SA) on liver outcome in patients affected by polycystic liver disease is still lacking. We performed a meta-analysis of RCTs and a trial sequential analysis (TSA) evaluating the effects of SA in adult patients with polycystic liver disease on change in liver volume. As secondary outcome, we evaluated the effects on quality of life as measured by SF36-questionnaire. Six RCTs were selected with an overall sample size of 332 adult patients with polycystic liver disease (mean age: 46 years). Mean liver volume at baseline was 3289 ml in SA group and 3089 ml in placebo group. Overall, unstandardized mean difference in liver volume was − 176 ml (95%CI, − 406, 54; p < 0.133). Heterogeneity was low (I2:0%, p < 0.992). However, we performed a moderator analysis and we found that a higher eGFR significantly correlates to a more pronounced effect of SA on liver volume reduction (p = 0.036). Cumulative Z-curve in TSA did not reach either significance and futility boundaries or required information size. Three RCTs have evaluated Quality of life parameters measured by SF36-QOL questionnaire for a total of 124 patients; no significant difference was found on the effect of SA on QOL parameters when compared with placebo. The present meta-analysis revealed a potential effect of SA on reduction of liver volume and quality of life parameters, but results did not reach a statistical significance. These data could be explained by the need of further studies, as demonstrated through TSA, to reach an adequate sample size to confirm the beneficial outcomes of SAs treatment.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Thomas Thorne ◽  
Simon Hughes ◽  
Rupaly Pande ◽  
Samuel Ford

Abstract Background Hepatic burden is a significant confounder in the assessment of impact of primary tumour resection in metastatic small bowel neuroendocrine tumours (SI-NET). For SI-NET metastatic hepatic burden &gt;10% disease replacement or &gt; 5 hepatic metastases are known prognostic markers, though nomograms and scores do not adequately account for this. Most trials do not adequately account for hepatic burden when assessing the survival difference between SI-NET primary tumour resection and no resection. We propose a sampling methodology to more accurately assess metastatic liver burden in SI-NET and correlate with delayed resection vs. upfront primary tumour resection at a specialist NET surgical unit. Methods Patients referred for metastatic SI-NET between January 2003 and February 2020 were identified from a prospective dataset. The earliest CT scan after diagnosis was used. The axial, coronal and sagittal slice position limits of the whole liver were recorded. These limits allowed equitable slice position of the liver, with 8 equally distributed axial, 4 equally distributed coronal and 4 equally distributed sagittal slices. Each slice was used to define the liver and metastatic area as assessed using liver CT windows. Liver burden was estimated as percentage total metastatic area summed from all 8 axial, 4 coronal and 4 sagittal slices. Results 157 total patients were on the collated data base and 46 patients were identified with an appropriate CT. Liver burden was positively skewed. Liver burden was significantly higher for delayed resection vs. upfront resection in all planes of assessment (axial: 11.61% vs. 0.14%, p = 0.003; coronal: 13.46% vs. 0.33%, p = 0.006; sagittal: 10.46% vs. 0.16%, p = 0.008). All planar assessments correlated well with one another (all Kendall’s tau ≥0.851, all p &lt; 0.001). Liver metastatic burden correlated with total liver volume (Kendall’s tau 0.549-0.573, all p &lt; 0.001). Conclusions Hepatic burden differs between resection groups in a small sample at our centre, highlighting the unmeasured confounders favouring primary tumour resection via positive bias. Therefore, hepatic burden needs quantifying in prospective studies that assess primary tumour resection in SI-NET. This is to ensure comparable groups after randomisation. Our method provides an assessment of this metastatic SI-NET liver burden.


2021 ◽  
Vol 15 (11) ◽  
pp. 3030-3033
Author(s):  
Amer Latif ◽  
M Akif Dilshad ◽  
Sumbul Naz ◽  
Sadia Jabbar ◽  
Faisal Naseer ◽  
...  

Aims & Objectives: Corner stone in performing living donor liver transplant is to assess and predict the adequacy of the donated liver for recipient and remaining liver. Previously the conversion of liver volume to estimated weight is done by using unit to unit conversion with a factor of 1. We analyzed data of our institute to research the methodology and local applicability of the same. Place and duration of study: Shaikh Zayed Hospital, Lahore. January 2011 to June 2017 Material & Methods: Retrospective data was collected for the first 115 recipients and donors. Their preoperative liver volumes calculated by C.T scan and post-operative graft harvested with weights were compared. Results: The parameter of actual volume of right lobe averaged to 769.77 ± 12.73 gm varying with a quantum of 17.73% (426 – 1123 gm). Estimated volume of right lobe of liver varied 358 to 1218 ml (CV = 17.84%) with an average value of 798.96 ± 13.29 ml. Results of linear regression between estimated volume of right lobe and actual weight of the right lobe in gm was significantly linear (r = 0.830, r2 = 0.690, adj. r2 = 0.689 and F = 250.98, p < 0.0001), showing that volumetric assessment overestimated graft weight/volume. Following is equation generated from our data for graft weight estimation. Actual right lobe (g) = 134.004 + 0.796 (estimated right lobe volume (ml) ± 76.42. Conclusion: Using one to one principle for volume estimation of healthy liver can be misleading and therefore we propose an equation to reach more accurate estimation of graft weight. Keywords: living donor liver transplant, CT volumetry, graft to body weight ratio


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