Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
Objective To evaluate the effect of pulse dye-densitometry by indocyanine green test (PDD-ICG)on the assessment of hepatic function reserve. MethodsSeventy-five hepatic carcinoma patients aimed to accept hepatectomy from March 2007 to February 2008 at West China Hospital were prospectively included in this study.Patients were grouped by dysfunction grade of hepatic function and the indexes before operation were compared.Furthermore, patients were grouped by K and R15 value to compare the moderate and severe liver dysfunction ratio, respectively. ResultsSixty cases manifested slight liver dysfunction,12 cases manifested moderate liver dysfunction,and 3 cases manifested severe liver dysfunction(the latter was took into moderate group due to the cases were too few).The difference of Child-Pugh score and common liver function examination indexes such as PT and INR before operation was not significant betweentwo groups(P＞0.05).ButPDD-ICG experiment indexes(K and R15)were remarkable different betweentwo groups(P＜0.05).The patients were divided into two groups according to K and R15 value,respectively.The rate of moderate and severe liver dysfunction was significant different between K＜0.158/min groupand K≥0.158/min group(47.1% vs. 12.1%,P＜0.05),and likewise moderate and severe liver dysfunction was significant different between R15≤10% group and R15＞10% group(15.9% vs.41.7%,P＜0.05）. ConclusionPDD-ICG is an effective and easyto evaluate hepatic function reserve of patient undergone hepatectomy.Therefore,it may give clinical instruction to predict and avoid the liver dysfunction after operation.
ObjectiveTo identify the risk factors of postoperative recurrence and survival for patients with hepatocellular carcinoma within Milan criteria following liver resection. MethodsData of 267 patients with hepatocellular carcinoma within Milan criteria who received liver resection between 2007 and 2013 in our hospital were retrospectively analyzed. ResultsAmong the 267 patients, 123 patients suffered from recurrence and 51 patients died. The mean time to recurrence were (16.9±14.5) months (2.7-75.1 months), whereas the mean time to death were (27.5±16.4) months (6.1-75.4 months). The recurrence-free survival rates in 1-, 3-, and 5-year after operation was 76.8%, 56.3%, and 47.6%, respectively; whereas the overall survival rates in 1-, 3-, and 5-year after operation was 96.6%, 82.5%, and 74.5%, respectively. Multivariate analyses suggested the tumor differentiation, microvascular invasion, and multiple tumors were independent risk factors for postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influenced the postoperative survival. ConclusionsFor patients with hepatocellular carcinoma within Milan criteria after liver resection, the tumor differentiation, microvascular invasion, and multiple tumors contribute to postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influence the postoperative survival.
ObjectiveTo investigate indications,technical points,and outcomes of laparoscopic liver resection in treatment for hepatic hemangioma. MethodThe clinical data of 78 patients with hepatic hemangioma underwent laparoscopic liver resection in our institute from January 2014 to December 2014 were analyzed retrospectively. ResultsSeventy-seven patients were underwent laparoscopic liver resection successfully,1 patient was conversed to open procedure.Operation method:laparoscopic anatomical liver resections were performed in 35 patients including 23 patients with left lateral segmentectomy,4 patients with left hemihepatectomy,3 patients with right hemihepatectomy,1 patient with Ⅲ segmentectomy,1 patient with Ⅵ segmentectomy,2 patients with Ⅵ and Ⅶ segmentectomy,1 patient with left lateral segmentectomy combined with Ⅵ and Ⅶ segmentectomy.Laparoscopic non-anatomical liver resection were performed in 43 patients.The operation time was (163.6 ±62.3) min,the intraoperative blood loss was (273.6±282.4) mL.No operative death occurred.One patient with postoperative functional bowel obstruction and 3 patients with pleural effusion had been recorded.All the patients recovered well.The postoperative hospital stay was (7.2±2.5) d.The results of postoperative pathology confirmed that all the tumors were hepatic cavernous hemangiomas. ConclusionsLaparoscopic liver resection for hepatic cavernous hemangioma is a safe and feasible method with small trauma,rapid recovery,cosmetic incision.Key of this technology is to strictly select surgical indications,to transect liver parenchyma along right plane,effective control of hepatic blood inflow,and properly management of cutting surface of liver.
ObjectiveTo follow-up pain after discharged in patients with liver resection and provide a reference to carry out the continued pain treatment outside the hospital. MethodsPost-discharged pain follow-up in patients with liver resection in our department from December 1, 2014 to April 30, 2015 were conducted, and the pain incidence, characteristics and level on 14 days, 1 month, 2 months, and 3 months after operation were understanded. Results①The pain score of patients on 14 days after operation was 0-3 points, which was mild pain. In 2 months after operation, 24 patients still had pain, the incidence was 20.69% (24/116). In 3 months after operation, the pain incidence was 18.97% (22/116).②There was no significant difference in the pain incidence between men and women in 2 months after operation (P > 0.05). In 3 months after operation, the pain incidence of male and female patients was 13.04% (9/69) and 27.66% (13/47), respectively, the pain incidence of female was significantly higher than men (P < 0.05).③The postoperative pain score and incidence in patients more than 60 years old were lower than that in patients less than 60 years old, but the score and the incidence of postoperative pain in patients with different ages were not statistically significant (P > 0.05).④In chronic pain patients, 81.82% (18/22) were visceral pain, 18.182% (4/22) were skin tingling or numbness. ConclusionWe should focus on the continued pain treatment outside the hospital in patients with hepatic resection, make efforts to alleviate pain, and improve the postoperative quality of life.
ObjectiveTo evaluate the effects of indocyanine green (ICG) fluorescence imaging in laparoscopic anatomic hepatectomy. MethodsThe clinical data of 26 patients who underwent ICG fluorescence-guided laparoscopic anatomic hepatectomy in the Department of Hepatobiliary Surgery at Affiliated Hospital of North Sichuan Medical College from March 2019 to May 2023 were retrospectively analyzed. ICG staining methods included combined lipiodol-ICG (SHIFT&nanoICG) hepatic artery embolization (anterograde staining) and (or) portal vein retrograde staining. Patient demographics, pathological characteristics, intraoperative outcomes (ICG staining method and results, operation time, intraoperative blood loss, transfusion rate, conversion to open surgery), and postoperative outcomes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TB) levels on postoperative day 3, hospital stay, complications] were analyzed. Quantitative data conforming to a normal distribution were described as mean ± standard deviation, while skewed distributions were described as median (interquartile range). The significance level was set at α=0.05. ResultsAmong 26 patients, 6 received combined anterograde (SHIFT&nanoICG) + retrograde staining (referred to as the “dual-staining group”), while 20 received retrograde staining alone (referred to as the “single-staining group”). One case (3.8%) in the single-staining group required conversion to open surgery. All resection margins were negative. No statistically significant differences were observed between the dual-staining group and the single-staining group for the following parameters: Tumor diameter [5.0 (4.4) cm vs. 4.0 (4.2) cm, P=0.483], operative time [307.0 (146.0) min vs. 250.0 (137.5) min, P=0.831], intraoperative blood loss [250.0 (225.0) mL vs. 225.0 (338.0) mL, P=0.756], postoperative hospital stay [(12.3±2.1) d vs. (10.9±2.7) d, P=0.232]. Furthermore, no significant differences were found in ALT, AST, ALB, and TB levels on postoperative day 3 (P>0.05). Regarding postoperative complications (classified according to the Clavien-Dindo system): One patient with grade Ⅰ complication was recorded in the dual-staining group, 3 with grade Ⅰ and 3 with grade Ⅱ complications were recorded in the single-staining group, no grade Ⅲ or higher complications occurred in either group. Comparison of complication rate between the two groups showed no statistically significant difference (P=0.600). ConclusionsBoth conventional ICG and SHIFT&nanoICG provide effective fluorescence guidance for laparoscopic anatomic hepatectomy. For patients with hepatocellular carcinoma who are ineligible for primary radical resection or have lost the opportunity for initial curative surgery, SHIFT&nanoICG provides superior intraoperative fluorescence visualization following transarterial embolization-assisted conversion therapy.
ObjectiveTo explore it's advantages and disadvantages through analyzed the data of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) operation in 3 cases of liver cancer patients with cirrhosis. MethodsThe data of 3 patients perfomed ALPPS operation were retrospectively analyzed, through the preoperative evaluation, intraoperative and postoperative treatment points analyzed to explore the pros and cons. ResultsOne case died of hepatic failure, and the remaining two cases were still alive. The highest score of MELD of liver failure in death case was 18.8 scores, and the other cases of MELD score were decreased after second operation. The average increased volume of liver was 225 mL, and the liver volume was significantly increased (P=0.002). ConclusionsALPPS make a portion of huge liver cancer patients combining with cirrhosis having a chance to surgery. But it is necessary to consider in patients with preoperative state, surgical risk, prognosis and economic conditions,in order to determine whether patients can benefit from ALPPS.