Retrospect and prospect of associating liver partition and portal vein ligation for staged hepatectomy / 中华消化外科杂志

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is introduced as a modified two staged hepatectomy for advanced liver malignancies,which requires extended hepatectomy with very small future remnant liver volume.It is characterized by rapid and large growth of future remnant liver and potential of widening the indication of curative resection with extended major hepatectomy for liver malignancies.However,it showed much higher morbidity of complications and mortality than extended hepatectomy after portal vein embolization.The development of ALPPS is often controversial.In this article,the development and problems of ALPPS are retrospected and summarized,in order to reflect the role of ALPPS in Japan where zero mortality after hepatectomy is highly expected.

Intraoperative ultrasonography for repeated hepatic resections for hepatocellular carcinoma / 中华肝胆外科杂志

Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.