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Surgical resection in patients with advanced primary carcinoma of liver has high risks of early recurrence and incidence of portal vein tumor thrombus, caused by insufficient resi-dual liver volume after two-steps hepatotomy. At present, the treatment for patients with advanced primary carcinoma of liver is limited, thus can't satisfy the requirement of patient for treatment. The authors introduce the clinical experience of a patient with hepatocellular carcinoma and insufficient residual liver volume who underwent preventive immunotherapy plus target therapy after associa-ting liver partition and portal vein ligation for staged hepatectomy, in order to provide reference for relevant treatment.
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Along with the development of liver transplant techniques, clinical efficacy of liver transplantation has been significantly improved, and the survival of the recipients and liver grafts has been remarkably prolonged. However, the source of organ donation after citizen' s death still fails to meet the requirement of liver transplantation. The shortage of donor liver limits further development of liver transplantation. In recent years, living donor liver transplantation has been widely used in the treatment of patients with end-stage liver disease as one of the means to resolve organ shortage. As a special type of living donor liver transplantation, right posterior segmental graft liver transplantation provides a novel solution for expanding the potential donor pool for living donor liver transplantation. In this article, the development profile of living donor liver transplantation, donor selection of right posterior segmental graft for living donor liver transplantation, anatomical challenges of right posterior segmental graft procurement and surgical skills of right posterior segmental graft procurement were reviewed. Moreover, the prospect of right posterior segmental graft for living donor liver transplantation was predicted, aiming to promote the development of liver transplantation in clinical practice and bring benefits to more patients with end-stage liver diseases.
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Objective: To assess the value of residual liver volume ratio measured with CT for preoperative evaluation in pediatric hepatoblastoma. Methods Totally 40 hepatoblastoma patients confirmed by pathology with the average age of (1.8±0.8)years were enrolled. All patients underwent pre-operation enhanced CT scan. The total liver volume, the predicted resected liver volume were measured, and the standard liver volume, the residual liver volume were calculated, respectively. The residual liver volume ratio was calculated with the formula of residual liver volume ratio=residual liver volume/standard liver volume×100%. The volume of the actual resected liver was measured by water immersion method and then compared with the volume of the pre-resected liver measured with CT. ROC curve was used to evaluate the efficacy of residual liver volume ratio for prediction of moderate and severe liver dysfunction. Results: The predicted resected liver volume and actual resected liver volume was (393.62±216.54)cm3 and (388.38±207.56)cm3, respectively, with no significant difference (t=1.679, P=0.101). The residual liver volume was (234.55±70.42)cm3, and the residual liver volume ratio was (63.64±13.70)%. AUC of ROC curve for prediction of moderate and severe liver dysfunction was 0.837 (P=0.016), the critical value was 56.32%, and the sensitivity and the specificity was 86.7% and 70.0%, respectively. Conclusion: The preoperative calculation of residual liver volume ratio with CT in children with hepatoblastoma is a great value in the selection of surgical option and evaluation of postoperative liver function.
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Surgical resection is the first choice for liver cancer therapy.In order to transform the unresectable part into resectable one,surgeons manage to ensure adequate liver reserves by making the wanted liver tissue become hypertrophy and let the unwanted one become atrophy.However,though ALPPS (associating liver partition and portal vein ligation for staged sepatectomy) as an alternative operation plan in its initial developing stage now becomes a hot topic,it is still under great controversy.The author believes that it is imperative to draw up a personalized plan and carry out a strict and reasonable multicenter-clinical trial for those patients to get an opportunity to conduct a safe and effective operation.
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Objective To evaluate the feasibility and efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) followed by selective portal venous embolization (PVE) in patients with marginally resectable hepatocellular carcinoma (HCC).The aim was to find out whether this combined procedure helped to increase the rate of extended radical liver resection.Methods From March 2009 to November 2016,29 patients with HCC which were marginally resectable underwent preoperative TACE combined with PVE were included into this study.All these patients were subsequently assessed to undergo radical hepatectomy.The complications,laboratory results,volume changes of each liver lobe and patient survival were analyzed.Results TACE combined with PVE was successful in all the 29 patients.There were no major complications.After the procedure,the volumes of the tumor and the part of the liver to be resected decreased to certain degree.The remnant liver volume (RLV) increased remarkably.The RLV were (395.4 ±58.7) cm3 and (599.2 ±75.2) cm3 before and after the procedure,respectively.The difference was significant (P ＜ 0.05).19 patients underwent radical hemihepatectomy or trisectionectomy,with a resection rate of 65.5％ (19/29).There were sufficient surgical margins in all the resected tumors.After operation,the 1-,3-,and 5-year survival rates were 58.8％,35.5％ and 17.6％,respectively.Conclusion For HCC patients who had marginally resectable HCC,preoperative TACE combined with PVE efficiently controlled the growth of the tumors,decreased the volume of the liver lobe with tumor,increased the RLV,and made it possible for a planned two-stage radical hepatectomy with sufficient surgical margin and better survival in a significant proportion of patients.
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BACKGROUND: Recently, numerous right hepatectomies for living-related liver transplantation are being performed safely. However, donors rarely exposed to sustained hepatic dysfunction or hepatic failure. Liver volume is one of the important considerations of recipient and donor safety after transplantation. Therefore, we analyzed postoperative liver function test results in relation to residual liver volume fraction (%RLV) in right lobe donors. METHODS: The charts, anesthetic records and computerized hospital data of 124 donors registered for LRLT from April 2000 to September 2003 were retrospectively reviewed. Donors were divided into two groups: %RLV or = 40% (group L, n = 83). Residual liver volume, blood loss, fluids and blood administered, surgical and anesthetic times, and postoperative hospital stay were investigated. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT), and total bilirubin (TB) were analyzed before and immediately after operation, and on postoperative days 1, 2, 3, 5, 7, and 30. RESULTS: No significant differences in donor characteristics, blood loss, surgical and anesthetic times, or in postoperative hospital stay were observed between group S and group L. No significant differences in perioperative AST, ALT, PT, or TB were observed between two groups, and no correlation was observed between the postoperative peak liver function test levels and %RLV. CONCLUSIONS: The residual liver volume fraction did not correspond with liver function test results after donor right hepatectomy. Therefore, it is difficult to predict postoperative liver function by using residual liver volume fraction.