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Right trisectionectomy

M A Machado, R Surjan, T Basseres, F Makdissi
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. PATIENT: A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment...
October 12, 2016: Annals of Surgical Oncology
Kayvan Mohkam, Benjamin Darnis, Jean-Yves Mabrut
Porcine models of extended hepatectomy and liver transplantation (LT) of reduced graft have been widely used for studying the small-for-size (SFS) syndrome and the various modalities of portal inflow modulation (PIM). However, considerable heterogeneity exists among the studies and their results. The aim of this review was to assess the main advantages and drawbacks of the different porcine models of SFS LT and SFS hepatectomy, and propose a standardized anatomical nomenclature for the various models. The MEDLINE database was searched for articles reporting porcine models of reduced graft LT or hepatectomy of more than 65%...
October 6, 2016: Journal of Hepato-biliary-pancreatic Sciences
Nobuyuki Watanabe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Takashi Mizuno, Junpei Yamaguchi, Masato Nagino
BACKGROUND: No authors have reported on the anatomic features of the independent right posterior portal vein variant and its relevance to left hepatic trisectionectomy. The purpose of this study was to review vasculobiliary systems according to portal vein anatomy, to clarify the anatomic features of the right posterior portal vein variant, and to discuss its operative implications for left hepatic trisectionectomy. METHODS: In a radiologic study, the 3-dimensional anatomy of the portal vein, hepatic artery, and bile duct were studied in 200 patients who underwent computed tomography...
September 27, 2016: Surgery
P P Li, H Liu, S Y Fu, C Lin, Z Y Pan, J Zhang, J S Ni, S X Yuan, W P Zhou
OBJECTIVE: To discuss the application of liver visualization technology in complex liver tumor resection at the second hepatic portal area. METHODS: Clinical data of 80 cases who received surgery at the second hepatic portal area from August 2014 to September 2015 in the Third Department of Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital were analyzed retrospectively. There were 58 male and 22 female patients aged from 21 to 70 years with median age of 52 years...
September 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Rodrigo C Surjan, Fabio F Makdissi, Tiago Basseres, Denise Leite, Luiz F Charles, Regis O Bezerra, Erik Schadde, Marcel Autran Machado
BACKGROUND: ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is a new surgical approach for the treatment of liver tumors. It is indicated in cases where the future liver remnant is not sufficient to maintain postoperative liver function. We report a totally laparoscopic ALPPS with selective hepatic artery clamping. Pneumoperitoneum itself results in up to 53% of portal vein flow and selective hepatic artery clamping can reduce blood loss while maintaining hepatocellular function...
July 2016: Medicine (Baltimore)
Matteo Ravaioli, Matteo Serenari, Matteo Cescon, Carlo Savini, Alessandro Cucchetti, Giorgio Ercolani, Massimo Del Gaudio, Alberto Casati, Antonio Daniele Pinna
BACKGROUND: Leiomyosarcoma of vascular origin is a rare tumor, occurring mainly in the inferior vena cava (IVC). When involving the hepatic vein confluence, it often causes Budd-Chiari syndrome, and IVC removal with a complex hepatectomy is required (Mingoli in J Am Coll Surg 211:145-146, 2010; Griffin in J Surg Oncol 34:53-60, 1987; Heaney in Ann Surg 163:237-241, 1966; Fortner in Ann Surg 180:644-652, 1974). METHODS: A 57-year-old male, without previous oncological history, presented with Budd-Chiari syndrome due to a leiomyosarcoma extending to the supra-diaphragmatic IVC and involving the right and middle hepatic veins...
July 18, 2016: Annals of Surgical Oncology
Masahito Uji, Takashi Mizuno, Tomoki Ebata, Gen Sugawara, Tsuyoshi Igami, Keisuke Uehara, Masato Nagino
Although surgical resection is the only way to cure biliary tract cancer (BTC), most BTCs are unresectable by the time they are diagnosed. Chemotherapy is usually used to treat unresectable BTC, but its impact on survival is small. Here, we report the case of a 70-year-old woman with a locally advanced intrahepatic cholangiocarcinoma that was initially diagnosed as an unresectable liver metastasis from colon cancer that had invaded all of the major hepatic veins. However, the tumor was noticeably reduced after treatment with CAPOX plus bevacizumab, which is an uncommon therapy for BTC...
December 2016: Surgical Case Reports
Sung Hyun Kim, Hae Min Lee, Seung Ho Lee, Jong Yoon Won, Kyung Sik Kim
Portal hypertension can arise from any condition interfering with normal blood flow at any level within the portal system. Herein, we presented two uncommon cases of the portal hypertension and its treatment with brief literature review. A 71-year-old man who underwent right hemihepatectomy revealed a tumor recurrence adjacent to the inferior vena cava (IVC). After radiofrequency ablation (RFA) with lymph node dissection, he was referred for abdominal distension. The abdomen computed tomography scan showed severe ascites with a narrowing middle hepatic vein (MHV) and IVC around the RFA site...
May 2016: Korean Journal of Hepato-biliary-pancreatic Surgery
B Stoffels, S J Enkirch, M W von Websky, T O Vilz, D Pantelis, S Manekeller, N Schäfer, J C Kalff
BACKGROUND: Posthepatectomy liver failure (PHLF) is one of the most serious complications after major liver resections and an important factor in terms of perioperative morbidity and mortality. Despite many advances in the understanding and grading of PHLF, the definitions found in literature are very heterogeneous, which complicates the identification of high-risk patients. In this study we analysed the results of extended liver resections and potential risk factors for PHLF based on patient data derived from our tertiary referral centre...
August 2016: Zentralblatt Für Chirurgie
Eduardo de Souza Martins Fernandes, Felipe Tavares de Mello, Joaquim Ribeiro-Filho, Asterio Pinto do Monte-Filho, Moacir Martins Fernandes, Romulo Juventino Coelho, Monique Couto Matos, Antonio Augusto Peixoto de Souza, Orlando Jorge Martins Torres
BACKGROUND: Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma. AIM: To present 10-year experience performing this operation in advanced malignant tumors. METHODS: This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68...
March 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Rodrigo C Surjan, Tiago Basseres, Denis Pajecki, Daniel B Puzzo, Fabio F Makdissi, Marcel A C Machado, Alexandre Gustavo Bellorio Battilana
Surgical resection is the treatment of choice for malignant liver tumours. Nevertheless, surgical approach to tumours located close to the confluence of the hepatic veins is a challenging issue. Trisectionectomies are considered the first curative option for treatment of these tumours. However, those procedures are associated with high morbidity and mortality rates primarily due to post-operative liver failure. Thus, maximal preservation of functional liver parenchyma should always be attempted. We describe the isolated resection of Segment 8 for the treatment of a tumour involving the right hepatic vein and in contact with the middle hepatic vein and retrohepatic vena cava with immediate reconstruction of the right hepatic vein with a vascular graft...
2016: Journal of Surgical Case Reports
Junjie Hong, Xiaofeng Zhang, Raojun Luo, Xiujun Cai
INTRODUCTION: The occurrence of bile leakage (BL) is one of the major contributors to the morbidity after hepatectomy. However, the clinical risk factors associated with postoperative BL remains controversial. This study aims to further assess the risk factors for BL. EVIDENCE ACQUISITION: We comprehensively searched the electronic databases of PubMed, EMBASE, Web of Science and the Cochrane Library for studies published before October 10th, 2015. Cohort studies, case-control studies, and randomized controlled trials that examined clinical risk factors for BL were included...
February 2016: Minerva Medica
Maciej Malinowski, Johan Friso Lock, Daniel Seehofer, Bernhard Gebauer, Antje Schulz, Lina Demirel, Jan Bednarsch, Victoria Stary, Peter Neuhaus, Martin Stockmann
PURPOSE: Post-hepatectomy liver failure (PHLF) is the major risk factor for mortality after hepatectomy. Preoperative planning of the future liver remnant volume reduces PHLF rates; however, future liver remnant function (FLR-F) might have an even stronger predictive value. In this preliminary study, we used a new method to calculate FLR-F by the LiMAx test and computer tomography-assisted volumetric-analysis to visualize liver function changes after portal vein embolization (PVE) before extended hepatectomy...
September 2016: Surgery Today
Samuel W Ross, Ramanathan Seshadri, Amanda L Walters, Vedra A Augenstein, B Todd Heniford, David A Iannitti, John B Martinie, Dionisios Vrochides, Ryan Z Swan
BACKGROUND: The predictive value of the Model for End-stage Liver Disease (MELD) for mortality after hepatectomy is unclear. This study aimed to evaluate whether MELD score predicts death after hepatectomy and to identify the most useful score type for predicting mortality. We hypothesized that an increase in this score is correlated with 30-day mortality in patients undergoing hepatic resection. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for hepatectomy...
March 2016: Surgery
Charalampos Farantos, Nikolaos Arkadopoulos, Pantelis Vassiliu, Panagiotis Kokoropoulos, Nikolaos Economopoulos, Aggeliki Pandazi, Vassilis Smyrniotis
Right trisectionectomy for posterior liver tumors engaging the right and middle hepatic veins may lead to post-hepatectomy liver failure if the anticipated liver remnant is small. In such patients we developed a parenchyma-sparing one-step approach, that includes extrahepatic right portal vein ligation accompanied by en bloc resection only of segments 7, 8 and 4a and resection of the right and middle hepatic veins. The technique was applied in 3 patients with normal liver function, where according to the preoperative computed tomography the volume of segments 1, 2 and 3 ranged between 17% and 20% of the total liver volume...
October 2015: Hepatobiliary & Pancreatic Diseases International: HBPD INT
K Urata, T Ikegami, Y Nakazawa, Y Ohno, A Kobayashi, A Mita, K Sano, M Kurozumi, S Miyagawa
We report the case of a 58-year-old man referred to our hospital for liver tumor treatment. The patient had a history of neurosurgery for a meningeal hemangiopericytoma 16 years previously. Pre-operative imaging revealed a hypervascular tumor extending from Couinaud segment 4 to segment 8 of the liver, measuring 95 mm in diameter, indicating an atypical hepatocellular carcinoma. Because right trisectionectomy of the liver was considered to be high risk, living-donor liver transplantation (LDLT) was indicated...
September 2015: Transplantation Proceedings
Tomoaki Hirose, Tsuyoshi Igami, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Takashi Mizuno, Kensaku Mori, Masahiko Ando, Masato Nagino
BACKGROUND: Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma, due to the anatomic consideration that "the left hepatic duct is longer than that of the right hepatic duct". However, only one study briefly mentioned the length of the hepatic ducts. Our aim is to investigate whether the consideration is correct. METHODS: In surgical study, the lengths of the resected bile duct were measured using pictures of the resected specimens in 475 hepatectomized patients with perihilar cholangiocarcinoma...
December 2015: World Journal of Surgery
Albert C Y Chan, Ronnie T P Poon, Chung Mau Lo
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a highly complex operation that demands a thorough understanding of the intrahepatic vascular anatomy and skills in parenchymal transection for the in situ split procedure. In order to minimize adhesion formation after the stage I operation and to avoid iatrogenic tumor rupture during right liver mobilization in large tumors, anterior approach appears to be a logical approach for the in situ split procedure...
November 2015: World Journal of Surgery
Christopher R Shubert, Elizabeth B Habermann, John R Bergquist, Cornelius A Thiels, Kristine M Thomsen, Walter K Kremers, Michael L Kendrick, Robert R Cima, David M Nagorney
INTRODUCTION: Safety of synchronous hepatectomy and colorectal resection (CRR) for metastatic colorectal cancer remains controversial. We hypothesized that both the extent of hepatectomy and CRR influences postoperative outcomes. METHODS: Prospective 2005-2013 ACS-NSQIP data were retrospectively reviewed for mortality and major morbidity (MM) after (1) isolated hepatectomy, (2) isolated CRR, and (3) synchronous resection for colorectal cancer. Hepatectomy and CRR risk categories were created based on mortality and MM of respective isolated resections...
November 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Daisuke Hokuto, Takeo Nomi, Ichiro Yamato, Satoshi Yasuda, Shinsaku Obara, Takatsugu Yamada, Hiromichi Kanehiro, Yoshiyuki Nakajima
Portal vein arterialization (PVA) has been applied as a salvage procedure in hepatopancreatobiliary surgeries, including transplantation and liver resection, with revascularization for malignancies. Here we describe the use PVA as a salvage procedure following accidental injury of the hepatic artery to the remnant liver occurred during left hepatic trisectionectomy for colorectal liver metastases (CRLM). A 60-year-old man with cancer of the sigmoid colon and initially unresectable CRLM received 11 cycles of hepatic arterial infusion chemotherapy with 5-fluorouracil (1500mg/week), after which CRLM was downstaged to resectable...
2015: International Journal of Surgery Case Reports
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