The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 7 cm are suitable candidates. Concerning location, tumors in the lower segment and the left lateral segment are good candidates. Favourable operative procedure are partial hepatectomy and left lateral sectionectomy. Recently, we have successfully experienced of laparoscopic hepatectomy of recurrece HCC, Giant HCC or tumor located upper segment and hemihepatectomy. The operative procedures were 37 partial hepatectomy cases, 20 left lateral segmentectomy cases, 2 S6 segmentectomy , 2 posterior sectionectomy cases, 2 left hemihepatectomy cases and 1 right hemihepatectomy case ...
Introduction: We report our experience with laparoscopic major liver resection in Korea based on a multicenter retrospective study. Materials and methods: Data from 1,009 laparoscopic liver resections conducted from 2001 to 2011 were retrospectively collected. Twelve tertiary medical centers with specialized hepatic surgeons participated in this study. Results: Among 1,009 laparoscopic liver resections, major liver resections were performed in 265 patients as treatment for hepatocellular carcinoma, metastatic tumor, intrahepatic duct stone, and other conditions. The most frequently performed procedure was left hemihepatectomy (165 patients), followed by right hemihepatectomy (53 patients). Pure laparoscopic procedure was performed in 190 patients including 19 robotic liver resections. Hand-assisted laparoscopic liver resection was performed in three patients and laparoscopy-assisted liver resection in 55 patients. Open conversion was performed in 17 patients (6.4 %). Mean operative time and ...
Bleeding is a major problem during liver resection. Vascular inflow occlusion, also known as Pringle maneuver, has been commonly employed to reduce blood loss during liver surgery. However, Pringle maneuver might cause ischaemic insult to the remnant liver and lead to post-operative liver dysfunction.. The investigators hypothesize that liver resection without the use of vascular inflow occlusion (Pringle maneuver) is associated with lower postoperative complications rate.. The aim of this study is to evaluate whether elective open liver resection without vascular inflow occlusion (Pringle Maneuvre) would lead to a reduction of post-operative surgical complications in patient with hepatocellular carcinoma.. Eligible patients undergoing liver resection in the Prince of Wales Hospital will be recruited and randomized into 2 study arms comparing the effect of Pringle maneuver. ...
TY - JOUR. T1 - Risk factors for early recurrence after curative hepatectomy for colorectal liver metastases. AU - Yamashita, Yo Ichi. AU - Adachi, Eisuke. AU - Toh, Yasushi. AU - Ohgaki, Kippei. AU - Ikeda, Osamu. AU - Oki, Eiji. AU - Minami, Kazuhito. AU - Sakaguchi, Yoshihisa. AU - Tsujita, Eiji. AU - Okamura, Takeshi. PY - 2011/4/1. Y1 - 2011/4/1. N2 - Purpose. With the broadening indications for hepatectomy to treat colorectal liver metastases (CRLM), early recurrence is a major problem. The aim of this study is to identify risk factors of early recurrence, defi ned as recurrence within 1 year after surgery. Methods. A retrospective analysis was performed on 121 consecutive patients who underwent hepatectomy for CRLM. Results. Among 121 patients, 52 (43.0%) developed early recurrence. The independent risk factor for early recurrence was "number of liver metastases ≥3" (odds ratio 2.65). There were signifi cantly more patients with liver recurrence (51.9%) and recurrence beyond curative ...
Liver diseases are known to affect the function of remote organs. The aim of the present study was to investigate the effects of Pringle maneuver, which results in hepatic ischemia-reperfusion (IR) injury, and partial hepatectomy (Hx) on the pharmacokinetics and brain distribution of sodium fluorescein (FL), which is a widely used marker of blood-brain barrier (BBB) permeability. Rats were subjected to Pringle maneuver (total hepatic ischemia) for 20 min with (HxIR) or without (IR) 70% hepatectomy. Sham-operated animals underwent laparotomy only. After 15 min or 8 h of reperfusion, a single 25-mg/kg dose of FL was injected intravenously and serial (0-30 min) blood and bile and terminal brain samples were collected. Total and free (ultrafiltration) plasma, total brain homogenate, and bile concentrations of FL and/or its glucuronidated metabolite (FL-Glu) were determined by HPLC. Both IR and HxIR caused significant reductions in the biliary excretions of FL and FL-Glu, resulting in significant increases
BACKGROUND: Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC).. METHODS: Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4+/-8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were ...
Portal vein embolization (PVE) is an effective procedure to increase the future remnant liver (FRL) before major hepatectomy. A controversial issue is that PVE may stimulate tumor growth and can be associated with poor prognosis after liver resection for colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of PVE on long-term survival following major hepatectomy for CRLM.Between 1998 and 2010, 100 right and extended-right hepatectomies for unilobar, right-sided CRLM were performed. Of the group, 20 patients underwent preoperative PVE (group A). The control patients (group B; 20 patients) were selected by matching with the group A patients.It was found that 25 patients (25/40; 62.5\%) had developed tumor recurrence. The rate of global recurrence was not significantly different in groups A and B (65\% vs 60\%, respectively; P = .744). The specific overall intrahepatic recurrence rate was 42.5\% (17 of 40 patients) and was not significantly different in groups A and ...
Background Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques...
Eren Berber, MD. Cleveland Clinic. Objective: Over the last decade, techniques have been developed for laparoscopic liver resection (LLR). Still, one of the drawbacks is the dependency on multiple different devices for various steps of the procedure. Ideal would be to have a device that could be used to divide and provide hemostasis to the parenchyma, while also serving as a vessel sealer. Herein, we demonstrate a new 5 cm radiofrequency vessel sealing/dividing device (Caiman, Aesculap Inc., Center Vllaey, PA) that combines these features for LLR.. Methods: The device was used in 2 recent LLR cases. The first patient had ocular melanoma metastases in segment 3 and the second patient carcinoid metastases to segment 3.. Results: The first patient underwent laparoscopic left lateral sectionectomy using the Caiman vessel sealer and divider. The operation time was 89 minutes with an unremarkable blood loss. She was discharged home on postoperative day (POD) 2 and her drain was removed on POD 7. Final ...
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Fretland, Åsmund Avdem; Dagenborg, Vegar Johansen; Bjørnelv, Gudrun Maria Waaler; Kazaryan, Airazat M.; Kristiansen, Ronny; Fagerland, Morten; Hausken, John; Tønnessen, Tor Inge; Abildgaard, Andreas; Barkhatov, Leonid; Yaqub, Sheraz; Røsok, Bård Ingvald; Bjørnbeth, Bjørn Atle; Andersen, Marit Helen; Flatmark, Kjersti; Aas, Eline & Edwin, Bjørn (2018). Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Annals of Surgery. ISSN 0003-4932. 267(2), s 199- 207 . doi: 10.1097/SLA.0000000000002353 Vis sammendrag Objective: To perform the first randomized controlled trial to compare laparoscopic and open liver resection. Summary Background Data: Laparoscopic liver resection is increasingly used for the surgical treatment of liver tumors.However, high-level evidence to conclude that laparoscopic liver resection is superior to open liver resection is lacking. Methods: Explanatory, assessor-blinded, single center, randomized superiority ...
Background: Reducing postoperative complications remains a dominant challenge for all clinicians. By minimizing the incidence of adverse outcomes, health care costs and patient recovery can be improved. A number of studies have documented that fewer postoperative adverse events occur with the preoperative use of glucocorticoids (GC). Two small manuscripts support the use of GC with particular reference to liver resection.. Major hepatectomy can be associated with numerous adverse outcomes (hemorrhage, bile leak, liver failure, wound infection other infectious complications). This rate approaches 54% in some trials. Additionally, the liver is responsible for numerous metabolic functions and actively participates in the acute phase response via the generation of inflammatory mediators and cytokines. Glucocorticoids play an important role in suppressing the over-synthesis of pro-inflammatory cytokines and therefore may assist in reducing postoperative complications. These pro-inflammatory cytokines ...
Totally laparoscopic living donor hepatectomy is a complex procedure with a steep learning curve requiring experienced teams with a commitment to technical excellence; it is not a random act but rather a gradual evolutionary process, decades in the making. See case reports by Samstein et al (page 2462), Soubrane et al (page 2467) and Troisi et al (page 2472). ...
It is not rare that two-stage hepatectomy for multiple bilobar colorectal liver metastases (CLM) be left incomplete because of disease progression or te
Liver echinococcus | Partial liver resection. Surgery: Treatment in Marburg, Germany ✈. Prices on BookingHealth.com - booking treatment online!
Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH ...
Analysis of the risk factors for early death due to disease recurrence or progression within 1 year after hepatectomy in patients with hepatocellular carcinoma : Liver resection for hepatocellular carcinoma (HCC) has the highest local controllability among all local treatments and results in a good survival rate. However, the recurrence rates of HCC continue to remain high even after curative hepatectomy Moreover, it has been reported that some patients with HCC have an early death due to recurrence. We analyzed the preoperative risk factors for early
TY - JOUR. T1 - Laparoscopic surgery for large left lateral liver tumors. T2 - safety and oncologic outcomes. AU - Yang, Tsung-Han. AU - Chen, Jen Lung. AU - Lin, Yih-Jyh. AU - Chao, Ying-Jui. AU - Shan, Yan-Shen. AU - Hsu, Hui-Ping. AU - Su, Che-Min. AU - Chou, Chung Ching. AU - Yen, Yi-Ting. PY - 2018/10/1. Y1 - 2018/10/1. N2 - Background: Although laparoscopic hepatectomy has been proven to be safe and reliable, the influence of tumor size on the feasibility of laparoscopic left lateral segmentectomy (LLLS) is unclear. We retrospectively reviewed our surgical results focusing on hepatic tumor located in the left lateral segment. Methods: From January 2003 to June 2016, patients who underwent left lateral segmentectomy were retrospectively reviewed, and data were collected on patient characteristics, peri-operative outcomes, and pathologic results. Patients with intrahepatic stone, cystic lesion, or unmeasurable tumor size were excluded. The continuous variables were compared using the ...
Malignant melanoma is an extremely aggressive cancer arising from melanocytes, associated with the development of metastases in up to 20% of patients. Although the liver is a frequent metastatic site of malignant melanoma, primary hepatic melanoma (PHM) is rare. The treatment of PHM is controversial, and the prognosis for affected patients remains poor. We present two PHM patients who underwent partial hepatectomy at our institution and review the clinical and pathological data from these cases. Our results suggest that it is difficult to make a preoperative diagnosis of PHM without pathological results. For patients with resectable PHM, surgical resection is a potentially curative treatment.
Gastroenterology Research and Practice is a peer-reviewed, Open Access journal that provides a forum for researchers and clinicians working in the areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis, and therapy of gastrointestinal diseases.
Background Hepatic resection is not applicable to the majority ofhepatocellular carcinoma (HCC) patients due to insufficient liverfunction reserve. Cardiotrophin-1 (CT-1), a member of the inter-leukin-6 family, has demonstrated protective and pro-proliferativeeffects in the myocytes and hepatocytes.Aim The present study aimed to investigate the potential role ofCT-1 in rescuing marginal cirrhotic liver remnant in a rat orthotopicHCC model.Materials and Methods Liver cirrhosis was induced by subcuta-neous injection of CCL4 for 8 weeks. The rat orthotopic HCC model was generated by injecting HCC cells into the left lobe of the liver.Animals received the following treatments: 1) hepatectomy only, n =6; 2) CT-1 (2 µg/kg) intraportal vein injection (i.pv) right after hepa-tectomy, n = 6; 3) CT-1 (2 µg/kg) i.pv right after hepatectomy, and 1µg/kg intraperitoneal injection (i.p) 24 hr after hepatectomy, n = 6; 4)CT-1 (2 µg/kg) i.p 24 hr before hepatectomy, n = 6; 5) CT-1 (2 µg/kg)i.p 24 hr before ...
Type beta transforming growth factor (TGF-beta), a factor produced by many cell types, is a potent inhibitor of hepatocyte DNA synthesis in vitro. To determine whether TGF-beta can influence hepatocyte proliferation in vivo, its effects were examined on the regenerative response of liver to partial hepatectomy (PH) in the rat. Porcine platelet-derived TGF-beta 1 (0.5 micrograms), administered intravenously at the time of PH and 11 hr later, reduced the fraction of hepatocytes engaged in DNA synthesis 22 hr after PH by 67% and inhibited the rate of hepatic [3H]thymidine incorporation by 50%. TGF-beta 2 produced a similar effect. A single dose of 0.5 micrograms of TGF-beta 1 given 11 hr after PH reduced liver [3H]thymidine incorporation by 32%; 4.5 micrograms of TGF-beta 1 or TGF-beta 2 inhibited DNA synthesis by 88% and the labeling index by 86%. Although sensitive to TGF-beta administered 11 hr after PH, late in the G1 phase of the cell cycle, a single dose of 0.5 micrograms given at the time of ...
Transgenic mice expressing DN RAGE in cells of MP lineage display enhanced survival and liver regeneration after massive hepatectomy. Transgenic mice expressing human DN RAGE selectively in cells of MP lineage using the scavenger receptor type A promoter were used for these studies. (A-D) Immunofluorescence microscopy. Immunofluorescence for detection of RAGE antigen was performed in sections prepared from the remnants of transgenic mice 8 h after sham surgery (A) or massive resection (B, 85%). Double immunofluorescence staining was performed on sections prepared from transgenic mice 8 h after massive resection using the following antibodies: anti-RAGE IgG (C and D, green) and anti-CD68 IgG (C, red) or anti-CD11c IgG (D, red). Single and merged images are shown. (A and B) Bars, 100 μm; (C and D) Bars, 50 μm. (E) Kaplan-Meier Product Limit Estimate. The times of death were recorded for transgenic versus littermate control mice undergoing massive hepatectomy and survival was plotted. (F and G) ...
Diagnosis and treatment of cancer of the bile duct with partial hepatectomy (costs for program #275070) ✔ Klinik Im Park ✔ Department of General and Abdominal Surgery ✔ BookingHealth.com
Right hepatectomy is a standard anatomical procedure used worldwide, and consists of two important steps: access to the portal pedicle at the hepatic hilus and approach through the right hepatic vein. With interest in the early work in the field of right hepatectomy, we searched for official documents, published not only in English but also non-English languages for insights on the history of the great work conducted by pioneer liver surgeons in the East and West. To discuss anatomical right hepatectomy, it is important to consider several issues, including liver anatomy, other anatomical liver resection procedures, control of vascular in-flow and out-flow, operative procedures or approaches, preoperative management and other related issues ...
Changes in binding of dexamethasone (9α-fluoro-11β, 17α,21-trihydroxy-16α-methylpregna-1,4-diene-3,20-dione) to its receptors in regenerating rat liver after 70% hepatectomy were examined. Specific receptors for dexamethasone in the liver remnants of adrenalectomized rats decreased significantly during the period of DNA synthesis after 70% hepatectomy; then, they increased to above the control values between Days 4 and 7 after partial hepatectomy and subsequently returned to the control values. During the period of DNA synthesis, decreased binding was observed in partially hepatectomized rats with or without adrenals, but later enhanced binding was not prominent in rats with adrenals.. ...
Ellsmere, J., Kane, R. & Jones, D.B. Reply to: Re: Intraoperative ultrasonography during planned liver resections remains an important surgical tool ((2007) 21: 1280-1283). Surg Endosc 22, 1913 (2008). https://doi.org/10.1007/s00464-008-9942-8. Download ...
Introduction Women with visceral metastases of breast cancer are usually considered to have a poor prognosis. A small subgroup of patients, however, present with liver metastases as the only manifestation of recurrence. The discussion whether this subgroup might benefit from an aggressive approach including liver resection is still ongoing and remains controversial. The decrease in mortality and morbidity rates has led to a broadening of the indication for hepatic resection. Design This was a case series study. Methodology Between January 2011 and December 2013, nine adult female patients underwent liver resection for liver metastases from breast cancer. Patients were considered for surgical management if they were fit for major operation; hepatic resection can be performed with adequate residual liver volume, intact inflow and outflow, and biliary drainage, and no extrahepatic disease on preoperative imaging except for limited and stable bone metastases. Hepatic resection was performed using ...
Objective(s) of the proposed study: - The evaluation of the efficiency of 18F deoxyglucose-Positron Emission Tomography (FDG-PET) in stag
Hepatic resections are performed as a part of the surgical management for benign or malignant pathologies of the liver, while most of them are primary or secondary liver tumors. With the aid of this workshop, you will learn about the different types of hepatic resections, recall some of the liver anatomy and even test your knowledge of the hepatic blood supply and distribution. After laying the theoretical foundation, you will perform typical and atypical hepatic resections, and you will also become more familiar with the Pringle manoeuvre.. ...
Multiple Choice Test 1) Most extensive hepatic resection is : One answer only. a) Right Trisegmentectomy b)
Hello all:)this is my first post since under going lower left lobectomy for carcinoid lung tumour. I wanted to share as prior to surgery many post I read were both informative and actually encouarging too. My surgery was performed 18th June 2012, just like everybody who gets informed they have tumour I was petrified and my mind went into overdrive like I never knew it could. On being advised best treatment option for me, was lobectomy I want to run as far away as possible and just not deal with this health issue at all. thankfully the little bit of sense I keep in reserve, always, finally kicked in and having researched and read helpful posts from others who had been through same procedure I went for it too. Without doubt day 2 after surgery was like..... OMG how will I ever be the same again. Pain was fairly controlled by medication but I did feel awful, however each and every day there after things just got better & better. For me I would say first 4/6 weeks not feeling great and truly ...
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Mouse Oval Cell Marker, 0.1 ml. Facultative liver stem cell activation was originally described in the rat, where chemical damage and partial hepatectomy caused the emergence of a new cell type, the oval cell.
Mouse Oval Cell Marker, 25 µl. Facultative liver stem cell activation was originally described in the rat, where chemical damage and partial hepatectomy caused the emergence of a new cell type, the oval cell.
Liver is a unique tissue which is able to regenerate in response to partial hepatectomy (PH) and after injury. My laboratory investigates the role of transcript...
Liver is a unique tissue which is able to regenerate in response to partial hepatectomy (PH) and after injury. My laboratory investigates the role of transcript...
If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.. As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their livers regenerative ability may be significantly impaired and resection may be unsafe. Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver). If a liver resection is recommended, it will be carried out under a general anaesthetic, which means youll be asleep during the procedure and wont feel any pain as its carried out.. Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover. ...
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Background: Living donor liver transplantation remains the predominant option for patients with acute or chronic liver failure in many regions with poor cadaveric donation rates. Over the years, the donor mortality and donor liver failure has been minimized due to improvement in selection and surgical expertise. However like any major liver resections, the risk of bleeding, reoperations and readmissions remains. Aim: Analysis of Reoperation and Readmission rates following Living Donor Hepatectomy from a single center from Western India. Methods: Retrospective analysis of records of living donors who required re-exploration and / or readmissions after Living donor hepatectomy performed between April 2013 & October 2016 at a single center. Results: 137 Donor hepatectomies were done during this period (121 Right Liver grafts and 16 Left lobe and Left lateral segment grafts). The mean age of Donors was 36 years (20 to 58) with a male preponderance ( M/F :1.6/1). There was no mortality (30 day and 90 ...
The inflammatory response has been shown to be a major contributor to acute kidney injury. Considering that laparoscopic surgery is beneficial in reducing the inflammatory response, we compared the incidence of postoperative acute kidney injury between laparoscopic liver resection and open liver resection. Among 1173 patients who underwent liver resection surgery, 222 of 926 patients who underwent open liver resection were matched with 222 of 247 patients who underwent laparoscopic liver resection, by using propensity score analysis. The incidence of postoperative acute kidney injury assessed according to the creatinine criteria of the Kidney Disease: Improving Global Outcomes definition was compared between those 1:1 matched groups. A total 77 (6.6%) cases of postoperative acute kidney injury occurred. Before matching, the incidence of acute kidney injury after laparoscopic liver resection was significantly lower than that after open liver resection [1.6% (4/247) vs. 7.9% (73/926), P < 0.001]. ...
Background With the development of laparoscopic skills, its application has expanded in living donor liver transplantation. However, due to technical difficulties, pure laparoscopic donor hepatectomy (PLDH) is performed few centers. In this report, we compare the safety and early outcomes of PLDH and open donor hepatectomy (ODH). Moreover, the learning curve of each group was analyzed and compared during the experienced period.. Methods Total of 78 consecutive living liver donors underwent the right hepatectomy from January 2010 to March 2017. Of these, 43 living donors underwent the ODH and the 35 donors underwent the PLDH. Two donors of the PLDH group underwent open conversion due to bleeding and large graft size. The learning curve was defined using the moving average method.. Results Except for the size of the right portal vein (PLDH 13.4± 6.3 mm, ODH 10.8± 3.2; p=0.03) donor demographic including age, sex, body mass index (BMI), fatty change and vascular and biliary anomaly were ...
The process of liver regeneration after partial hepatectomy is very complex and is associated with signalling cascades involving initiation signals, transcription factors, cytokines, growth factors, tissue remodelling and termination of growth related signals. To date the exact mechanism of liver regeneration remains poorly understood. Toll-like receptor 4 (TLR4) acts as a sensor for immune signals and plays a critical role in host defence. It is known that lipopolysaccharide (LPS) is one of the ligands for TLR4. Binding of LPS to TLR4 leads to activation of transcription factor, nuclear factor kappa B (NF-κB) via the intracellular adaptor molecule, myeloid differentiation factor 88 (MyD88), which in turn activates the production of proinflammatory cytokines, TNF-α and IL-6. Evidence suggests that LPS/TLR4 signalling may be involved in liver regeneration following partial hepatectomy, as delayed liver regeneration and impaired cytokine responses were observed in C3H/HeJ mice, a mouse that is ...
Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been successfully applied to increase the future liver remnant before a right trisectionectomy. Tumor infiltration to the right portal vein is a challenge situation. Material and methods: A patient with advanced gallbladder carcinoma underwent exploration. Intraoperative finding showed tumor infiltration of the right portal vein and the duodenum. In-situ split of the left lateral liver lobe combined with postoperative right portal vein embolization completed the concept of ALPPS.. Results: Successful right trisectionectomy in combination with whipple operation without tumor residual could be achieved 8 days later, while the liver remnant increased from 491 ml to 911 ml. Neither post-hepatectomy liver failure nor postoperative anastomotic leak has been observed. 3 month follow up has not shown any sign of tumor recurrence. Conclusion: In-situ split combined with postoperative right portal vein ...
Studies on the hyperplasia (regeneration) of the rat liver following partial hepatectomy. Changes in lipid peroxidation and general biochemical aspects
Prabhakaran, K.,Patankar, Jahoorahmad M.V.,Neo, Grace T.H. (2004). Chylous ascites following liver resection - Case report. Pediatric Surgery International 20 (9) : 719-721. [email protected] Repository. https://doi.org/10.1007/s00383-004-1281-9 ...
Portal vein embolization (PVE) is a preoperative procedure performed in interventional radiology to initiate hypertrophy of the anticipated future liver remnant a couple weeks prior to a major liver resection procedure. The procedure involves injecting the right or left portal vein with embolic material to occlude portal blood flow. By occluding the blood flow to areas of the liver that will be resected away, the blood is diverted to healthy parts of the liver and induces hyperplasia. This may allow for a more extensive resection or stage bilateral resections that would otherwise be contraindicated resulting in better oncological treatment outcomes. Indications for PVE depend on the ratio of future liver remnant (FLR) to total estimated liver volume (TELV) and liver condition. Although there is no consensus to the absolute minimum liver volume required for adequate post-resection liver function, a FLR/TELV ratio of at least 25% in recommended in patients with otherwise normal livers. The ...
The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection. Serum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of |1.5x the pre-operative value. The median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P | 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeons assessment of liver parenchyma, blood
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The Glissonean pedicle transection method has been reported to shorten operation time, reduce intraoperative blood loss, and minimize surgical risks in HCC patients undergoing hepatectomy 22. The Glissonean approach may therefore be more beneficial for HCC patients undergoing curative resection than other hilar vascular control methods such as the Pringle maneuver. However, in a large series, only 17.1% of patients underwent major hepatectomy involving two or more segments, with most patients (80.3%) undergoing segmentectomy or subsegmentectomy18. Our patient cohort differs in the extent of liver resection as well as including only patients with large (, 5 cm) nodular HCCs. 56% Of the 25 patients in our Glissonean group, 14 (56%) underwent removal of more than 2.5 segments (right trisegmetectomy).. To our best knowledge, our study is the first to compare the surgical effectiveness and safety of Glissonean transection with the Pringle maneuver in patients with large HCC undergoing radical ...