ABSTRACT
Objective To evaluate the feasibility of precise hepatic segmentectomy or subsegmentectomy using intraoperative image-guided interventional intravascular segmental vessel balloon catheter occlusion of the segmental hepatic artery and portal vein.Methods 6 patients with liver resection carried out from 2011.3-2011.8 were retrospectively analyzed.Results The mean operating time was (270.83±21.31) min,the median of blood loss was 800 ml,the median of intraoperative transfusion volume was 450 ml.The tumors were mainly located in segments Ⅴ,Ⅵ,Ⅶ,Ⅷ.The mean diameter of tumor was (5.67±1.03) cm.Postoperative liver function in the first postoperative day showed the mean alanine aminotranferase (ALT) was (570.00±157.76) U/L,the mean aspirate aminotrarsferase (AST) was (410.00 ±189.94) U/L,and the mean total bilirubin (TBIL) was (10.83± 1.60) mmol/L.Liver function recovered to normal within 7 days.There was intestinal leakage and wound dehiscence in one patient,pleural and effusion in two patients.Conclusion Imageguided interventional intravascular segmental vessel balloon catheter occlusion was a safe and efficacious maneuver.This technique allowed hepatic segmentectomy or subsegmentectomy to be carried out,decreased intraoperative bleeding,and protected the function of the liver remnant.
ABSTRACT
Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.