Hepatectomy Surgery Research Articles

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

BackgroundTo evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery.MethodsThirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS).ResultsThe use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 16 months. The 1-, 2-, and 3-year LTP rates were 2.9, 5.7 and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1, 86.8 and 69.5%.ConclusionIn patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.

Pure laparoscopic living donor hepatectomy: learning curve, technical pearls and pitfalls

Living donor liver transplant (LDLT) has markedly reduced waiting list mortality and expanded access to life-saving therapy for thousands across the globe. Application of minimally invasive surgery to donor hepatectomy has been markedly slower than in many other aspects of surgery. For donors undergoing hepatectomy, many long-lasting issues related to donation appears to involve the large incision typically used for donor hepatectomy. This has provided significant motivation for a minimally invasive approach to donor hepatectomy. Pure laparoscopic donor hepatectomy was initially reported in 2002 but adoption has been slowed by concerns about hemostasis, donor safety and recipient outcomes. Highly select centers have successfully developed minimally invasive living donor programs and have been reporting outcomes and techniques utilized. We review the technical approaches have been learned by early adopters. We discuss some of the pitfalls and challenges associated with laparoscopic donor hepatectomy. We discuss the reported experiences with the learning curve for this complex operation. We discuss the future of minimally invasive surgery for donor hepatectomy.

Robotic hepatectomy has improved outcomes as compared to open surgery as predicted by the ACS nisquip risk calculator

Presenter: Imran Siddiqui MD | St. Vincents Medical Center Background: Robotic hepatectomy is safe and feasible when performed by trained surgeons.Universal adoption is limited due to the complexity of the operation and the steep learning curve as well as inherent risks associated with liver resection including bleeding. We describe in our series consecutive robotic hepatectomies performed in a community hospital with emphases on evaluating the predicted (ACS NISQUIP) and observed outcomes. Methods: Consecutive patients undergoing liver resection surgery by a robotic fellowship trained HPB surgeon at a community hospital setting were evaluated for demographics, pathology, post-operative complications, length of stay, ACS NISQUIP risk score for any and serious complications, 90-day mortality, 30-day readmission, preoperative embolization as well as conversion to open surgery. All liver surgeries performed by the surgeon are done using the robotic Da'Vinci XI platform. Results: 22 consecutive patients underwent robotic hepatectomy surgery. Median: Age was 56.5y, BMI was 29.5. Median expected LOS was 6 days and actual LOS 3 days. Median ACS risk for any complications was 20% and for serious complications was 18%. Median for observed rates of any complications was 13.7%. Major hepatectomy was performed in 31.5% and post-operative bleeding occurred in 4.5% and infection in 13.7%. There was an associated major procedure (Colon resection, pancreaticoduodenectomy etc. ) in 18.7% of patients. There was no mortality and 4.5% readmission rates. There was 87.7% R0 resection rates in this cohort. Conclusion: Although this is not a large series, it does demonstrate that robotic hepatectomy is safe to perform even in a community hospital setting provided there is technical expertise to do. The outcomes are superior to open surgery as predicted by the ACS NISQUIP risk calculator. In addition, the outcomes are seen even in the learning curve phase of a fellowship trained HPB surgeon.

Accuracy of estimated total liver volume formulas before liver resection

BackgroundFuture remnant liver volume is used to predict the risk for liver failure in patients who will undergo major liver resection. Formulas to estimate total liver volume based on biometric data are widely used to calculate future remnant liver volume; however, it remains unclear which formula is most accurate. This study evaluated published estimate total liver volume formulas to determine which formula best predicts the actual future remnant liver volume based on measurements in a large number of patients who underwent associating liver partition and portal vein ligation for staged hepatectomy surgery. MethodsAll patients with complete liver volume data in the associating liver partition and portal vein ligation for staged hepatectomy registry were included in this study. Estimate total liver volume and estimated future remnant liver volume were calculated for 16 published formulas. The median over- or underestimation compared with actual measured volumes were determined for estimate total liver volume and future remnant liver volume. The proportion of patients with an under- or overestimated future remnant liver volume for each formula were compared with each other using a 25% cut-off for each formula. ResultsAmong 529 studied patients, the formulas ranged from a 19% underestimation to a 63% overestimation of estimate total liver volume. Estimation of future remnant liver volume lead to a 10% underestimation to a 5% overestimation among the formulas. Of all studied formulas, the Vauthey1 formula was the most accurate, generating underestimation of future remnant liver volume in 20% and overestimation of future remnant liver volume in 6% of patients. ConclusionValidation of 16 published total liver volume formulas in a multicenter international cohort of 529 patients that underwent staged hepatectomy revealed that the Vauthey formula (estimate total liver volume = 18.51 × body weight + 191.8) provides the most accurate prediction of the actual future remnant liver volume.

International consensus statement on robotic hepatectomy surgery in 2018.

The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Pure laparoscopic left hepatectomy using Arantius' ligament approach combined Glissonean pedicle approach (with video)

Introduction: We describe a novel extra-glissonian approach combined Arantius' ligament approach for totally laparoscopic left hepatectomy. The extra-glissonian approach and Arantius' ligament approach have proven useful in open surgery for left hepatectomy. And these approachs could be even more useful in the laparoscopic context. Methods: The study included 5 patients who underwent totally laparoscopic left hepatectomy between July 2016 and September 2017. Retracting the caudal stump of the ligament revealed a space between the left Glissonean pedicle and the liver parenchyma with a cotton tape and transected with an endostapler. Arantius’ ligament was then identified, encircled and divided. The left Glissonean pedicle was encircled extrahepatically. The parenchymal dissection then proceeded to the left hepatic vein, which was finally divided. The specimen was placed in a plastic endobag, and extracted through a suprapubic incision. Results: No postoperative mortality was encountered and no Glissonean injuries, including bleeding or biliary leakage, occurred. The mean length of surgery was 290±113 min, and the mean blood loss was 350±187 ml. The mean duration of hospital stay was 11.7±3.5 days. Pathology showed free surgical margins. Conclusion: The Arantius' ligament approach combined Glissonean pedicle approach appears to be feasible

Hepatic Protective Effect of Dexmedetomidine after Partial Hepatectomy Surgery: A Prospective Controlled Study.

Background:Inflow occlusion of the portal triad is a common blood loss-reducing method during hepatectomy which may induce ischemic-reperfusion injury of the remaining parts of the liver. Dexmedetomidine is used for reducing ischemic-reperfusion injury in hepatectomy.Aim:The aim of this study was to assess the protective effect of dexmedetomidine on liver after partial hepatectomy using inflow occlusion.Setting and Design:This prospective controlled, double-blinded, randomized study included any patients of either sex with age between 20 and 70 years, those in physical status American Society of Anesthesiologists Classes I and II, and those who were planned for partial hepatectomy.Patients and Methods:Patients with elective hepatectomy were randomized into dexmedetomidine group, which received dexmedetomidine at 0.3 mg/kg/h, and control group, which received a placebo.Statistical Analysis:Statistical analysis was performed using IBM SPSS software version 18. Data were tested using Kolmogorov–Smirnov test, independent t-test or Mann–Whitney U-test, and Chi-square or Fisher's exact test. The statistical significance was considered at P < 0.05.Results:Serum albumin, aspartate aminotransferase, alanine aminotransferase, prothrombin time were higher in control group in comparison to dexmedetomidine group. Hypotension duration was lower in control group in comparison to dexmedetomidine group. Vasoconstrictor usage, amount of blood loss, and colloid, crystalloid, and blood given to patients were higher in control group in comparison to the study group.Conclusions:Dexmedetomidine can protect the liver during hepatic resection surgery with inflow occlusion with decreasing blood loss and need for blood transfusion.

The Comparison of the Effect of Mannitol and N Acetyl Cysteine on Liver Function in Partial Hepatectomy.

The alterations in liver function in patients after major liver resection are complex. Partial hepatectomy surgery is considered as a selective therapeutic approach in many benign and malignant liver tumors, secondary metastases, and liver trauma. According to surgical techniques most often based on vascular control and hepatic venous closure (Pringle maneuver), related complications such as ischemia and decreased venous return during and after surgery can be seen. In this study, the effects of Mannitol and N-acetylcysteine, on liver function, after hepatectomy surgery, were compared. This study was shown that infusion N-acetylcysteine next to mannitol, in partial hepatectomy surgeries, was not the significant difference to improve liver function, hemodynamic status, and laboratory tests.

Enhanced recovery after surgery for hepatectomy – A single centre's attempt at reducing hospital stay

Introduction: Enhanced recovery after surgery (ERAS), is a safe, reliable and cost effective method to shorten hospital stay. This study was carried out to compare the outcomes of open hepatectomy managed with ERAS vs conventional care (CC). The primary objective was to observe whether the implementation of ERAS resulted in shorter postoperative hospital stay. Methods: A prospective observational study was carried out comparing outcomes on patients who underwent open hepatectomy from January 2010 to March 2017 in our institution. The ERAS protocol used has been validated to be safe and feasible for patients undergoing open hepatectomy. CC group were patients who underwent similar matched operations prior to the implementation of the protocol. Subjects were further divided into minor resection (≤ 2 segments) and major resection (≥ 3 contiguous segments). . Results: A total of 34 patients for ERAS and 48 patients for CC group were recruited. Postoperative hospital stay for ERAS was slightly shorter (5.6 days vs 6.4 days) p = 0.138 although not statistically significant. Compliance to target discharge in the ERAS group was 43.8% (7 patients) and 13.6% (3 patients) respectively. No difference in morbidity, mortality or readmission rates between the groups were observed. Conclusion: ERAS is safe and feasible for open hepatectomy. It has the potential to reduce postoperative hospital stay and accelerate recovery. Although not statistically significant, we believe that with a larger sample size and minor adjustments to the protocol, a more definitive result would be achieved favouring the use of ERAS.

Robotic-assisted right posterior segmentectomies for liver lesions: single-center experience of an evolutional method in left semi-lateral position.

Despite the popularity of minimally invasive surgery (MIS) for hepatectomy, limitations in the approach of the right posterior section of the liver remain. Although skills and approach techniques have been developed for hepatectomy of lesions in the posterior segments of the liver, most are performed laparoscopically and are limited to few experienced hands using rigid laparoscopic instruments. In this study, we tried a different approach area via the aid of a flexible robotic system. Since 2012, we have successfully completed more than 200 robotic hepatectomy procedures in our institution. Two different patient settings have been applied for right posterior segment lesions, including supine position as general setting in early cases and left semi-lateral decubitus setting in our later cases. The demographic data and perioperative outcomes between the two groups were analyzed in regard to different positioning. A total of 25 patients with right posterior segment lesions underwent robotic-assisted resection, 13 were placed in supine position and 12 in left semi-lateral position. The left semi-lateral group had significantly shorter operation time (306.0 versus 416.8min, p = 0.023), less blood loss (203.9 versus 1092.3mL, p = 0.030), and lower transfusion rates (0 versus 46.2%, p = 0.015). We described an evolutionary technique for robotic right posterior segmentectomies with the patient placed in left semi-lateral position. This method can be applied for most patients easily and is demonstrated as a safe and feasible approach in selected patients owing to its ability to overcome the difficulty of MIS hepatectomy for right posterior lesions.

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation.

Inferior and limited analgesic options/techniques during living donor hepatectomy surgery can result in pain and risks of morbidity, opioid-related adverse events (AEs), predisposition to the development of chronic pain and concerns of potential narcotic abuse. Traditional analgesia uses unimodal intravenous opioids that can cause significant side effects. Ketamine provides analgesia and may be opioid sparing, but use in living-donor hepatectomy has not been studied. Following human investigation committee approval and informed written consent, 47 liver donor patients over a 5-year period scheduled for surgery were categorized into one of three groups: 24 patients received no ketamine (Group 1), 9 received only intraoperative ketamine (Group 2) and 14 patients received intraoperative plus postoperative ketamine (Group 3). Subjects had access to opioid patient-controlled analgesia (PCA). Chart reviews (including operating room and intensive care unit) were collected and analysed for morphine consumption, pain-intensity scores, opioid-sparing effects, AEs of analgesics and for evidence of ketamine side effects on donor hepatectomy patients. There were no differences in patient demographics. Living donor hepatectomy patients receiving intraoperative ketamine that was continued postoperatively consumed fewer morphine-equivalents and had lower median pain scores than subjects from the other two groups. Ileus occurred in those not receiving ketamine, pruritus was lowest in Group 3, and there was no evidence or reports of ketamine-associated AEs. Perioperative ketamine for donor hepatectomy patients could safely provide improved analgesia and be opioid sparing when compared to PCA opioids alone, and there is no evidence of ketamine-related AEs at the dose and delivery methods described here during partial liver donation surgery.

Application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection

Objective To study the application of the cold cutting technique in transumbilical single-incision laparoscopic liver resection (TUSI-LLR), and to evaluate its feasibility and treatment results. Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University. In all these patients, the liver parenchyma was transected with the cold cutting technique. The operation time, intraoperative blood loss, postoperative complications, time to remove abdominal drain, and total hospital stay in the patients were analyzed. Results 11 of the 35 patients were male. The average age was (49.9±10.8) years. The average body weight was (63.2±11.1) kg. The diagnoses were hemangiomas in 18 patients, hepatolithiasis in 5 patients, malignant hepatocellular tumors in 5 patients, focal nodular hyperplasia in 3 patients, and others in 4 patients. There were 22 left lateral sectionectomies, 2 left hemihepatectomies, 11 wedge resections (8 in the left and 3 in the right). The operations were all successfully performed, with no conversion to conventional laparoscopic hepatectomy or open surgery. The average operation time was (112.2±51.0) minutes, and the intraoperative blood loss was (105.4±70.1) ml. No patients required intraoperative blood transfusion. The average surgery cost was (36 336.7±5 938.2) yuan. All patients recovered well, with no postoperative hemorrhage, bile leakage, or incisional wound infection. The average time periods for removal of the abdominal drain, and hospital stay were (4.5±1.2) days and (5.2±1.4) days, respectively. All the 35 patients were followed up (1~3 months), with no patients complaining of abdominal distension or abdominal pain. Conclusions The cold cutting technique in transumbi-lical single-incision laparoscopic liver resection was safe and feasible. Its benefits included the operative speed, the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients. Key words: Cold cutting technique; Liver resection, laparoscopic, single incision; Stapling devices

This video is about the laparoscopic colectomy combined hepatectomy surgery

This video is about the laparoscopic colectomy combined hepatectomy surgery

Enhanced Recovery after Surgery Programs for Liver Resection: a Meta-analysis

Background and AimsDue to the limited number of high-quality randomized controlled trials on enhanced recovery after surgery for hepatectomy, previous reviews have not been sufficiently comprehensive. Our objectives were to evaluate and compare the safety and efficacy of enhanced recovery after surgery programs and traditional care in patients undergoing open or laparoscopic surgery and to assess the optimized items for hepatectomy. MethodsWe searched the PubMed, Embase, and the Cochrane Library databases for all the relevant studies regardless of study design. We assessed the methodological quality of the included studies and excluded studies of poor quality. We performed a meta-analysis using RevMan 5.3 software. ResultsIn total, 19 original studies with 2575 patients, including four randomized controlled trials and 15 non-randomized controlled trials, were analyzed. The meta-analysis demonstrated that enhanced recovery after surgery programs could reduce morbidity, hospital stays and cost, blood loss, and time to bowel function recovery for both open and laparoscopic surgery without increasing mortality, readmission rate, or transfusion rate. Twelve items were essential for liver surgery. ConclusionsEnhanced recovery after surgery programs for hepatectomy are feasible and efficient. Further studies should optimize perioperative outcomes for liver surgery.

Progress of clinical application of anatomic resection and nonanatomic resection

Currently surgical resection is still the best therapeutic method to treat hepatocellular carcinoma, but the effects of different surgical methods on postoperative recurrence of hepatocellular carcinoma are still controversial. According to the technical points and developmental course of anatomical and non-anatomical hepatectomy, this paper analyzes the published literature and draws a conclusion that success of hepatectomy depends on exact balance between residual liver reserve function and radical resection of tumor. The risk of microvascular invasion is low for solitary tumor with a maximum diameter of less than 2 cm, the results of anatomic and nonanatomic hepatic resection are comparable. When the tumor's diameter of 2 to 5 cm in size, the risk of microvascular invasion increase, if the patients with good preserved liver function, the anatomical resection is superior to nonanatomic resection for better local control and inhibiting intrahepatic metastasis. In the full assurance of the margin cases, anatomical hepatectomy should be used. On the other hand, non-anatomical hepatectomy surgery has a lower stress risk and can maintaina better liver function reserve, which can be applied to the patients with impaired liver function. For patients with a tumor diameter more than 5 cm, multinodular tumor, microvascular invasion and severe liver cirrhosis, the focus is on the prevention of postoperative liver failure, so non-anatomic hepatectomy can be considered.

Nonstrict and individual enhanced recovery after surgery (ERAS) in partial hepatectomy.

BackgroundWe aimed to evaluate postoperative recovery and short-term outcomes of patients undergoing partial hepatectomy managed with a nonstrict and individual enhanced recovery after surgery (ERAS) program.MethodsA retrospective analysis of 168 partial hepatectomy patients in our institution was included. The discharged day and the respective impact of element application throughout the duration were analyzed.ResultsWhen all the required elements of ERAS were fully implemented, the median discharge day was 6. The more deviation occurred, the more delayed the patient discharged (P < 0.01). Preoperative ASA score, basic conditions of patients and ages were revealed closely associated with discharge day (P < 0.001). Without or an early removal of tubes and early oral feeding reduced hospital stay statistically (P < 0.01). Early discharge of patients (<3 days) did not show an increased complication incidence or readmission (P > 0.05).ConclusionNonstrict and individual use of ERAS in partial hepatectomy reduced postoperative length of stay without increasing complication rate. Our study proposes a modulation of ERAS according to the needs and acceptance of patients. In a word, better optionally required rather than mandatorily meet.

Interleukin17A Promotes Postoperative Cognitive Dysfunction by Triggering β-Amyloid Accumulation via the Transforming Growth Factor-β (TGFβ)/Smad Signaling Pathway

Although postoperative cognitive dysfunction (POCD) is relatively common in elderly patients who have undergone major surgery, the mechanisms underlying this postoperative complication are unclear. Previously, we have investigated the role of cytokine-mediated hippocampal inflammation in the development of POCD in a rat model. Here, we sought to determine in mice the role of cytokine interleukin17A (IL17A) in POCD and to characterize the associated signaling pathways. Old mice underwent hepatectomy surgery in the presence or absence of IL17A monoclonal antibody, and cognitive function, hippocampal neuroinflammation, and pathologic markers of Alzheimer’s disease (AD) were assessed. We found that the level of IL17A in the hippocampus was increased in hepatectomy mice and that cognitive impairment after surgery was associated with the appearance of certain pathological hallmarks of AD: activation of astrocytes, β-amyloid1-42 (Aβ1–42) production, upregulation of transforming growth factor-β (TGFβ), and increased phosphorylation of signaling mother against decapentaplegic peptide 3 (Smad3) protein in the hippocampus. Surgery-induced changes in cognitive dysfunction and changes in Aβ1–42 and TGFβ/Smad signaling were prevented by the administration of IL17A monoclonal antibody. In addition, IL17A-stimulated TGFβ/Smad activation and Aβ1–42 expression were reversed by IL17A receptor small interfering RNA and a TGFβ receptor inhibitor in cultured astrocytes. Our findings suggest that surgery can provoke IL17A-related hippocampal damage, as characterized by activation of astrocytes and TGFβ/Smad pathway dependent Aβ1–42 accumulation in old subjects. These changes likely contribute to the cognitive decline seen in POCD.

Abstract 3467: Androgen receptor expression reduces post-hepatectomy surgery recurrence risks of hepatocellular carcinoma

Abstract Introduction: Androgen Receptor (AR) promotes hepatocarcinogenesis, yet, suppresses HCC (hepatocellular carcinoma) progression of HCC mouse models. Yet, the translational value of AR expression in HCC patients is not clear. The CD90 membrane protein is cancer stem/progenitor cells (CSPC) marker, which can be detected in Circulating Tumor Cells (CTC). It's recognized as post-surgery HCC recurrence confounder. In this report, we examined the roles of AR expressions in post-hepatectomy HCC recurrence, and provide cellular and molecular insight to AR effect in HCC recurrence. Methods: We detected AR vs. CD90 expressions in primary tumor and CTC of HCC patients whom subjected to hepatectomy surgery to associated with HCC recurrence. In addition, we delineated the cellular and molecular mechanisms in AR knockout (ARKO)-HCC model, as well as in human HCC cell lines. Furthermore, systems biological approach was also introduced to examine AR-mediated gene expression pathways enrichment. Result: We found opposite association power of AR vs. CD90 that higher CD90 was related to higher risk; yet, higher AR was refer to lower risks of HCC recurrence. The mechanisms are summarized as follow: 1). AR suppresses CD90 through Histone 3H2A (H3H2A) acetylation: The AR vs. CD90 is reversely expressed in the specimens. The CD90+ cells increases in ARKO compared to that in wildtype (WT) mouse HCC. AR abolishes CD90 expression in two HCC cell lines, in which H3H2A upregulation and acetylation also noted. Knockdown of H3H2A could recover CD90 expression under AR effect. 2). AR reprogram gene expression to inhibit cell migration: AR suppresses HCC cell migration in an AR-level dependent manner with shifted gene expression pattern. Systems biological analysis revealed that low AR is related to cell-cycle enrichment gene settings; yet, shift to cell migration suppression setting while AR level increased. 3). AR promotes cell anoikis through facilitating cellular stress produced by resolving cytoskeletons (amorphosis) in circulation: AR promotes cell anoikis through a non-classical AR function, by which to activate PI3K/AKT- and ROCK-related cytoskeletal rearrangement stress while the cells in anchorage independent condition. Conclusion: To sum up, this report demonstrated that AR expressions could serves as prognostic marker for HCC recurrence. And there are three mechanisms involved: AR reduces CD90 population through epigenetic modification, AR inhibits cell migration through gene expression shift, and AR promote anoikis through increasing amorphosis stress. Citation Format: Wen-Lung Ma, Pei-Yin Liao, Chun-Chieh Yeh, Long-Bin Jeng, Hsueh-Chou Lai, Shang-Feng Huang, Fu-Ju Lei. Androgen receptor expression reduces post-hepatectomy surgery recurrence risks of hepatocellular carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3467. doi:10.1158/1538-7445.AM2015-3467

Minimally Invasive Approaches in Pancreatic and Liver Surgery

The rapid expansion of minimally invasive techniques over the last two decades has dramatically expanded the use of these approaches in hepatopancreaticobiliary surgery. While implementation of minimally invasive surgery has been slowed by the technically complex nature of liver and pancreatic surgery, the feasibility of laparoscopic and robotic major liver and pancreatic resections has been demonstrated at select centers. This review discusses the preoperative evaluation, indications and contraindications, operative techniques, and outcomes of minimally invasive major pancreatic and hepatic resections; including distal pancreatectomy, pancreaticoduodenectomy, right and left hepatectomy, segmentectomy, and ablative liver surgery. Tables list the clinical outcomes of large series of patients treated with laparoscopic and robotic approaches to each operation. Figures detail port placement and include a number of intraoperative photographs demonstrating anatomic and technical considerations. Videos of a robotic pancreaticojejunostomy and a robotic retropancreatic dissection are included to highlight some of the technical advantages of this approach. While the current literature suggests the safety and feasibility of minimally invasive pancreatic and liver surgery with encouraging early results, ongoing study is needed to more definitively demonstrate outcome benefits of these approaches while maintaining patient safety and oncologic principles and justifying costs associated with the technology. As more data emerges, it is likely that utilization of minimally invasive approaches for hepatopancreaticobiliary surgery will continue to expand. This review contains 12 figures, 2 videos, 10 tables, and 129 references.

Comparison of the clinical effect of laparoscopic partial hepatectomy and open surgery in treatment of hepatic hemangioma

Objective To investigate the efficacy of laparoscopic partial hepatectomy and open surgery in the treatment of hepatic hemangioma.Methods The clinical data of 45 cases of laparoscopic partial hepatectomy and 15cases of open surgery were retrospectively analyzed.The incision length,operative time,blood loss,start eating timeafter operation,postoperative drainage volume,postoperative hospital stay and incidence rate of complications werecompared between the two groups.Results The incision length,blood loss,start eating time after operation,postoperative drainage volume,postoperative hospital stay of laparoscopic partial hepatectomy group were [(4.5 ± 1.1) cm,(100.3 ± 33.7) ml,(1.5 ± 0.4) d,(112.2 ± 32.7) ml,(6.7 ± 1.5) d],which were better than those in the opensurgery group[(25.1 ±5.4)cm,(201.5 ±23.8)ml,(3.5 ±0.6)d,(230.3 ±43.7)ml,(11.3 ± 3.7)d],the differences were statistically significant between the two groups (t =1.977,2.023,1.989,2.015,2.025,P ＜ 0.05).The operation time of the open surgery group was (159.4 ± 20.5) min),that in laparoscopic partial hepatectomy group was (139.0 ± 21.7) min,the difference was not statistically significant (t =1.453,P ＞ 0.05).The incidence rate of complications in laparoscopic partial hepatectomy group was significantly lower than the open surgery group(x2 =3.013,P ＜ 0.05).Conclusion Compared with open surgery,laparoscopic partial hepatectomy has the advantages of less blood loss,faster recovery,and fewer complications in the treatment of hepatic hemangioma. Key words: Hepatic hemangioma; Laparoscopy; Hepatectomy