Surgical resection of hepatic tumor in segment IXb by anterior transhepatic approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and the effect of surgical resection of hepatic tumor originated from segment IXb.</p><p><b>METHODS</b>The cases with hepatic tumors in segment IXb who had been operated on between March 2003 and January 2007 were retrospectively reviewed.</p><p><b>RESULTS</b>A total of 15 tumors in segment IXb, including 13 primary liver cancers and 2 benign tumors with a mean diameter of (4.3 +/- 1.6) cm, were successfully resected by anterior transhepatic approach under sequential occlusions of portal tride and total hepatic vascularity or portal tride clamping only. There was no operative mortality,with a mean operative time of (190.3 +/- 37.6) min and a mean operative blood lose of (376.7 +/- 252.7) ml. All the patients had uneventful postoperative course except one who suffered from ascites and edema of the low body, which was successfully managed medically. The mean postoperative hospital stay was (13.3 +/- 6.0) d. During the follow-up of 1-47 months, two patients with benign tumor enjoyed a normal life. Among the 13 patients with primary live cancers, 1 patient died of recurrence, 2 patients remained alive with intrahepatic recurrence and 10 patients survived without any sign of relapse, with a median tumor-free survival time of 23.5 months.</p><p><b>CONCLUSIONS</b>Surgical resection of hepatic tumor in segment IXb, despite their sophisticated anatomic position, is feasible in technique with high safety. The local resection can provide the patients with potential to cure.</p>

Extended hepatic pedicle occlusion in major hepatectomy for primary liver cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the influence of extended hepatic pedicle occlusion (HPO) on hepatic ischemic/reperfusion (I/R) injury and intraoperative blood loss in major hepatectomy for primary liver cancer (PLC).</p><p><b>METHODS</b>Between June 2001 and December 2005, a total number of 843 patients with PLC had been operated on. Those whose hepatic pedicle were occluded continuously for or longer than 30 min during hepatectomy were retrospectively reviewed (continuous HPO group) and compared to the patients whose hepatic pedicle were occluded for the same length of time but intermittently (intermittent HPO group). The amount of intraoperative blood loss, the percentage of the patients who needed blood transfusion and postoperative liver biochemical tests were compared between the two groups.</p><p><b>RESULTS</b>There were 35 cases in continuous HPO group and 38 cases in intermittent HPO group with occlusion time between 30 min and 45 min. The two groups were matched for underlying liver disease ,preoperative liver function, tumor size and location, major intrahepatic vessel involvements and the types and extensions of the hepatectomies. The mean intraoperative blood loss in continuous HPO group was significantly less than that in intermittent HPO group (660 ml vs. 1054 ml, P < 0.05); accordingly, the percentage of patients who need blood transfusion in continuous HPO group was significantly lower than that in intermittent HPO group (48.6% vs. 78.9%, P < 0.01). Patients in both of the groups were recovered smoothly after operation, with no occurrence of liver failure.</p><p><b>CONCLUSIONS</b>The hepatic pedicle can be continuously occluded for 3045 min in cirrhotic patients with well compensated liver function, and when compared to routine intermittent HPO, continuous HPO significantly decreases the intraoperative blood loss and reduces the need for transfusion. Meanwhile it does not increase the hepatic I/R injury.</p>

Surgical management of small intrahepatic lesions adjacent to the major vasculature / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and the significance of surgical resection of small intrahepatic lesions adjacent to the major vasculature.</p><p><b>METHODS</b>The results of treatment were retrospectively reviewed in 40 patients who received operation for intrahepatic lesions less than 3 cm in diameter between Jan. 2003 and Dec. 2005. The lesions were all adjacent to the major vasculature in the liver.</p><p><b>RESULTS</b>In the 40 patients, a total of 44 small intrahepatic lesions were successfully resected with minimal morbidity and blood loss (mean 163 ml). A second lesion was found in 4 patients (10%) during intraoperative exploration. Histologically the lesion was malignant in 29 cases (including 4 cases with two lesions) and benign in 11 cases, with correct preoperative diagnosis in 62.5% of all cases. For 26 patients with hepatocellular carcinoma, the 1-, 2-, and 3-year postoperative survival rates were 90.1%, 83.2% and 64.7%, respectively, while the patients with benign lesions were cured with the operation.</p><p><b>CONCLUSIONS</b>Surgical resection of small intrahepatic lesions adjacent to the major vasculature is demanding but feasible and with satisfying effect. The significance of surgical management of these small lesions is not only excising the lesions but also making definite diagnosis and finding new lesions in some patients.</p>

Surgical treatment for the giant hepatic carcinomas occupying the central part of the liver / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the techniques and the effects of surgical resection of giant hepatic carcinomas which occupied the central part of the liver.</p><p><b>METHODS</b>A retrospective study was carried out of hepatectomies performed for central giant hepatic carcinomas. The hepatic tumors included in this study were hepatocellular carcinomas, cholangiocarcinomas and hepatic metastases which situated in the central part of the liver (segment IV, V, VIII, I) with a diameter of larger than 10 cm and involved hepatocaval confluence, retrohepatic inferior vena cava (IVC) as well as hepatic portal.</p><p><b>RESULTS</b>A total of 40 central giant hepatic carcinomas were successfully resected, with a mean diameter of 13.6 cm (range 10.5-19.0 cm). The types of the hepatectomies conducted were as follows: extended mid-hepatectomy in 9 cases, atypical mid-hepatectomy in 13 cases, extended left hepatectomy in 13 cases, total caudatectomy plus extended left hepatectomy in 3 cases and extended right hepatectomy in 2 cases. The mean operation time was 197 min (range 90 - 380 min) and the mean intraoperative blood lose 1,596 ml (range 300-11,000 ml), with operative mortality and morbidity being 0 and 20%, respectively. The postoperative 1, 3 and 5 year survival rates for the patients were 88%, 56% and 28%, respectively.</p><p><b>CONCLUSIONS</b>The hepatic carcinomas of central type, when larger than 10 cm in diameter, frequently involves all the hepatic portal, hepatocaval confluence and retrohepatic IVC. Surgical resection of this kind of tumor, though sophisticated in technique, is safe and effective and, therefore, the first choice of the treatments.</p>

Surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava / 中华外科杂志

<p><b>OBJECTIVE</b>To clarify the proper surgical procedure of treating hepatocellular carcinoma (HCC) with a tumor thrombus in the inferior vena cava (IVC).</p><p><b>METHODS</b>Four patients with HCC with a tumor thrombus in the IVC underwent hepatectomy and thrombectomy. Following hepatectomy, tumor thrombus was removed by incising the wall of the IVC in 3 patients and from the hepatic vein in one patient. The 3 patients underwent thrombectomy under either hepatic vascular exclusion (HVE) or Satinsky's vascular clamping.</p><p><b>RESULTS</b>All the operations were successful without operative death and major complications. The postoperative course was uneventful in 3 patients and pleural effusion occurred in one patient who needed thoracentesis. Follow-up showed 3 patients died after 30, 10 and 14 months, respectively, and one patient is alive for 7 months.</p><p><b>CONCLUSIONS</b>HCC with tumor thrombus in the IVC is operable and the proper procedure is hepatectomy plus thrombectomy.</p>