ObjectiveTo investigate the clinical application of laparoscopic right hemihepatectomy via anterior approach. MethodThe clinical data of 32 patients underwent laparoscopic right hemihepatectomy via anterior approach from June 2017 to May 2019 were retrospectively analyzed.ResultsThe laparoscopic right hemihepatectomies via anterior approach were successfully completed in the 32 patients, no one converted to laparotomy. The operation time was (315.5±36.7) min, the intraoperative bleeding was (340.8±105.4) mL, and the postoperative hospital stay was (8.9±1.7) d. The postoperative complications occurred in 6 cases, including 1 case of peritoneal effusion, 1 case of intraabdominal infection, 2 cases of bile leakage and 2 cases of pleural effusion combined with pulmonary infection, who were discharged after receiving the conservative treatment according to the symptoms. The results of postoperative pathology: 13 cases of hepatocellular carcinoma, 6 cases of intrahepatic cholangiocarcinoma, 7 cases of hepatic angioleiomyoma, 6 cases of intrahepatic bile duct stones. The average follow-up time was 12 months (range 1 to 24 months). During the follow-up period, 7 cases of hepatic angioleiomyoma and 6 cases of hepatolithiasis survived after operation. The intrahepatic metastases were found in 1 patient with hepatocellular carcinoma at 12 months and 2 cases of intrahepatic cholangiocarcinoma at 9 months and 11 months, respectively. The rest patients survived free tumor.ConclusionLaparoscopic right hemihepatectomy via anterior approach is safe and feasible, and has a satisfactory short-term efficacy.
ObjectiveTo introduce the basic principles of commonly used assessment methods for liver function reserve, and compare the advantages and disadvantages of various assessment methods, so as to provide a reference for hepatectomy of patients with hepatocellular carcinoma (HCC). MethodThe literature on evaluation methods of liver reserve function in patients with HCC at home and abroad in recent years was searched and summarized. ResultsFrom the results of literature review, the Child‐Pugh score and indocyanine green discharge test were the most commonly used to assess preoperative liver function reserve for patients with HCC. The application value of other examinations such as albumin-bilirubin score, gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), nuclear medical imaging in predicting post-hepatectomy liver failure was gradually being explored. ConclusionsThe combination of clinical parameters and volumetric studies is used to assess preoperative liver function reserve for patients with HCC. The clinical applications of nuclear medical imaging and Gd-EOB-DTPA-enhanced MRI make up for the deficiency of local liver function reserve evaluation, which are important examinations to assess liver function reserve after conversion therapy in the future. However, more domestic studies are still needed to confirm their values.
Objective To investigate feasibility and clinical efficacy of exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis. Methods The patients who had left extrahepatic bile duct stones with choledocholithiasis from January 2012 to December 2016 were retrospectively collected. Among these patients, 29 cases underwent an exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy (observation group) and 26 cases underwent an exploration and stone removal through choledochoscope via incision of common bile duct during laparoscopic left lateral hepatectomy (control group). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative nutritional, and complications rate were compared between these two groups. Results The operations were performed successfully and no perioperative death happened in both groups. There were no significant differences in the operative time and intraoperative blood loss between the two groups (P>0.05). Moreover, the postoperative hospital stay of the observation group was significantly shorter than that of the control group (P<0.05). In addition, there were no significant differences in the complications of the bile leakage, subphrenic infection, and biliary residual stones between the two groups (P>0.05). Also, the levels of prealbumin and the lymphocytes in the observation group were significantly higher than those in the control group on the 3rd and 6th day after the operation (P<0.05). Conclusions Preliminary results of limited cases in this study show that exploration and removal of stones through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis is relatively safe and reliable, its procedure is simplified, could avoid relevant complications due to biliary incision and T tube drainage.
ObjectiveTo investigate the impact of elevated fasting blood glucose (FBG) level after open radical hepatectomy on the early recurrence of hepatocellular carcinoma (HCC).MethodsThe clinical data of 112 patients with HCC who underwent the open radical hepatecomy from January 2013 to December 2014 in the Affiliated Hospital of Qingdao University were retrospectively analyzed. After the radical resection of HCC, 86 patients with level of FBG 3.9–6.1 mmol/L and 26 patients with level of FBG≥6.1 mmol/L were design into a normal FBG group and an elevated FBG group, respectively. The recurrence rates of HCC were compared between the two groups at 1- and 2-year after the opreation.ResultsThere were no significant differences between the 2 groups in the gender, age, history of alcohol drinking, hepatitis B history, preoperative ALT, AST, AFP and Child-Pugh classification, scope of hepatectomy, intraoperative hemorrhage, hepatic blood flow occlusion, diameter of maximal tumor, histopathological differentiation, tumor number, cirrhosis, satellite lesion, postoperative adjuvant TACE treatment or not (P>0.05). The postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86) in the normal FBG group and 42.3% (11/26) and 61.5% (16/26) in the elevated FBG group, respectively, showing significant differences between the 2 groups (P<0.05). The results of multivariate analysis showed that the level of FBG≥6.1 mmol/L, low histopathological differentiation, and no postoperative TACE treatment were the independent risk factors affecting tumor-free survival rate after the open radical resection of HCC (P<0.05). ConclusionsElevated FBG level after open radical resection has a stimulative effect on early recurrence of HCC. As a result, monitoring and controlling of FBG level after operation is helpful in decreasing early recurrence rate of patients with HCC.
Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To diagnose and treat a patient with obstructive jaundice and hepatic bile duct tumor by multi-disciplinary team (MDT) and to provide individualized treatment. Methods By MDT model, a patient with obstructive jaundice and hepatic bile duct tumor, who was ever misdiagnosed as hilar cholangiocarcinoma, was discussed. The diagnosis, perioperative period management, and operation scheme were carried out by the MDT. Results After discussion of MDT, the patient was diagnosed as " hepatocellular carcinoma with bile duct tumor thrombi”, not " hilar cholangiocarcinoma”. Although hepatocellular carcinoma with bile duct tumor thrombi was end-stage disease, radical treatment was still considered. A plan of treatment was carried out by the MDT. Firstly, the percutaneous transhepatic cholangial drainage was operated for the predicted reserved half liver to relieve biliary obstruction. Secondly, hemihepatectomy combined with bile duct resection was carried out by the surgery team. The patient had nice postoperative recovery and there was no tumor recurrence after 6-month follow-up after surgery up to now. Conclusions MDT model do not only reduce misdiagnose, but also can provide the best therapeutic regimen and individualized treatment for patient presented with obstructive jaundice and hepatic bile duct tumor.
ObjectiveTo study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The three-dimensional (3D) reconstruction, 3D visualization, 3D printing, and augmented reality (AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode, operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. ResultsThere were 23 patients in this study, including 18 males and 5 females, with (56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was (865.2±165.6) mL and the virtual resected liver volume was (1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was (298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was (330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation (P<0.05), and then which began to rise on the third day and basically rose to the normal range; prothrombintime, total bilirubin, alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation (P<0.05), then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases. ConclusionFrom preliminary results of this study, it could improve surgical safety and precision of hepatectomy for huge HCC by preoperative precise assessment and operation navigation in good time of multimode imaging technology.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
ObjectiveTo understand the incidence and mechanism of posthepatectomy acute pancreatitis (PHAP) after liver resection, and to explore diagnosis, treatment, and preventive strategies to enhance prognosis for the patients with PHAP. MethodThe literature on studies relevant PHAP both domestically and internationally was retrieved and reviewed. ResultsThe incidence rate of PHAP was approximately 0.7% by the literature. The exact etiology was still unclear. According to the existing research results, it was speculated that the pathogenesis might be related to the portal vein congestion, reactive oxygen species, surgical trauma, and other factors. At present, there were no comprehensive guidelines for the diagnosis and treatment of PHAP after liver resection both domestically and internationally. The diagnosis was mainly based on the clinical manifestations, early signs and symptoms, biochemical examination and imaging evaluation. The treatment principle of the PHAP was similar to that of common acute pancreatitis. The symptomatic supportive treatment was performed for the patients with mild to moderate PHAP, while the surgical treatment and minimally invasive surgery were chosen for the severe PHAP. The best way prevented for PHAP was the preoperative comprehensive evaluation of patients, and quit smoking and drinking, and so on. The careful operation should be performed during the surgical process to minimize portal vein congestion and reduce reactive oxygen species in blood vessels.The blood biochemistry, hematuric amylase, pancreatic function, and relevant infection indicators should be closely monitored after surgery, and abdominal ultrasound should be repeated several times to achieve early identification and timely treatment. ConclusionsAlthough the incidence rate of PHAP is not high, it is a serious surgical complication. The prevention, early detection, and early treatment should be strengthened for PHAP, and we should focuse on earlier and more accurate prediction model in future.
Objective To explore the impact of microvascular invasion (MVI) on the survival prognosis of patients after radical hepatectomy for hepatocellular carcinoma, to analyze its related risk factors and preoperative prediction methods, and to provide reference and support for the treatment of early postoperative recurrence. MethodsBy searching domestic and international medical literature databases, we screened studies related to MVI in hepatocellular carcinoma, focusing on the definition, grading, risk factors, preoperative prediction methods, and postoperative treatment strategies of MVI, and summarized the results of the existing studies. ResultsMVI was a well-established risk factor for the intrahepatic metastasis and early postoperative recurrence of hepatocellular carcinoma. Currently, various methods were employed to predict MVI, including laboratory indicators, imaging genomics, and genomics. The laboratory indicators used for prediction included alpha-fetoprotein, protein induced by vitamin K absence or antagonist-Ⅱ, hepatitis B virus, tumor diameter, vascular endothelial growth factor A, and circulating tumor cells. Imaging genomics involved preoperative MRI with irregular tumor shape and intra-voxel incoherent motion diffusion-weighted imaging D value < 1.16 × 10-3 mm2/S, CT enhancement imaging features with irregular tumor margins, multiple foci, and contrast-enhanced ultrasound portal venous and delayed phase scores. Genomics included the maximum variant allele frequency of circulating tumor DNA. In cases where MVI was detected after surgery, adjuvant therapy options had gained attention, such as transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, targeted therapy, immunotherapy, radiation therapy, antiviral therapy, and local treatment combined with systemic treatment. ConclusionsThe study of MVI and its targeted treatment strategies are important for reducing the postoperative recurrence rate of hepatocellular carcinoma and improving patient survival. The preoperative prediction model and postoperative treatment plan should be optimized in the future to provide more effective treatment reference for patients.