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ObjectiveTo systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma (HCC). MethodsPubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5.3 software was used for data analysis. The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio (OR) was used for the analysis of binary variables, weighted mean difference (WMD) was used for the analysis of continuous variables, and 95% confidence interval (CI) was calculated for these variables. ResultsA total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients (1054 in the mesohepatectomy group and 807 in the hemihepatectomy group). The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group (OR=037, 95%CI: 0.16-0.87, P=0.02), while there were no significant differences between the two groups in time of operation (WMD=15.17, 95%CI: -18.75 to 49.05, P=0.38), intraoperative blood loss (WMD=100.96, 95%CI: -15.29 to 217.21, P=0.09), mortality rate in the perioperative period (OR=0.55, 95%CI: 0.26-1.17, P=0.12), incidence rate of bile leakage after surgery (OR=1.32, 95%CI: 0.74-2.38, P=0.35), overall survival rate, and disease-free survival rate. ConclusionMesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy.
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Objective To investigate the application and advantages of alternative vascular hemihepatic occlusion in anatomic mesohepatectomy.MethodsThe clinical data of 57 patients with liver cancer who underwent operation in hepatobiliary surgery of Fuzhou general hospital from January 2014 to December 2017 were retrospectively analyzed.According to the surgery method, the patients were divided into observation group and control group, 34 cases in observation group were performed anatomic mesohepatectomy with alternative hemihepatic occlusion, 23 cases in control group were treated with non-anatomical liver lobectomy.The clinical effect of two groups were compared.Results The observation group was significantly better than the control group in terms of operation time, intraoperative blood loss, length of hospital stay, hospitalization costs, ALB at 1, 3, 5 days after surgery, ALT and AST at 1, 3, 5, 7 days after surgery, the differences were significant (P＜0.05).There was no perioperative deaths in the two groups.ConclusionApplied alternative hemihepatic vascular occlusion in anatomic mesohepatectomy can achieve good short-term curative effect and high safety.
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Objective To evaluate the safety of mesohepatectomy for centrally located large hepatic tumors.Methods The clinical data of 37 patients who underwent hepatectomy for centrally located large liver tumors in our hospital from October 2010 to August 2015 were retrospectively analyzed.During the operation,the left and right hemilivers were mobilized.Slings for the improved liver hanging maneuver and for selective hepatic vascular occlusion were placed.These slings were used when necessary in order to minimize occlusion and ischemia time to the residual liver,and to maximize the volume of functional liver remnant.Mesohepatectomy was carried out using a microwave hemostatic separator.The feasibility,its effects on preventing hemorrhage,the degree of liver damage and the postoperative complications were evaluated.Results The mean diameter of the neoplasms was (12.6 ± 7.2) cm.The vascular inflow occlusion time of the left and right hemilivers were (12.2 ±3.5) min and (18.5 ±7.1) min,respectively.The blood loss was (487 ± 352) ml.The amount of red blood cell transfusion was (2.7 ± 1.9) U.The operation time was (215 ± 72) min.TBIL,ALT and AST reached their peak levels on the 1 st day after operation and they were higher than before surgery (P ＜ 0.01).The levels were then significantly decreased on the 3rd day after operation.However,the TBIL (P ＜ 0.05),ALT (P ＜ 0.01) and AST (P ＜ 0.05) were higher than the preoperative level,and only returned to normal or were close to the preoperative value on the 7th day after operation (P ＞ 0.05).The initial increase in ALT was quick and then it slowed down,while the initial increase in AST was slow but it decreased quickly.Conclusions Mesohepatectomy for centrally located large hepatic tumors could safely be carried out using the liver hanging maneuver combined with selective hepatic vascular occlusion and a microwave hemostatic separator.This method has the advantages of causing less bleeding,liver damage and rapid recovery.
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Comprehensive treatment dominated by surgery is the mainstay in the treatment of hepatic cancer,and hepatectomy is still the most effective treatment method.Bile duct reconstruction after hepatectomy is still the difficult point for the treatment of hepatic cancer complicated by bile duct invasion.A 45-year-old patient with hepatic cancer and gallstone was admitted to the Affiliated Hospital of Guiyang Medical College,magnetic resonance cholangiopancreatography and enhanced computed tomography indicated that intrahepatic duct was dilated and tumor had invaded both left and right hepatic ducts.Cholecystectomy,mesohepatectomy,duct to duct anastomosis of left hepatic duct and common hepatic duct,duct to duct anastomosis of right hepatic duct and cystic duct were performed during the operation.The patient was cured 2 weeks after surgery.
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Objective To evaluate the safety and efficacy of mesohepatectomy for large and centrally located hepatocellular carcinoma.Methods A retrospective study was carried out on 136 pa tients who underwent mesohepatectomy for large and centrally located hepatocellular carcinoma at Xiangya Hospital,Central South University,from 2001 to 2007.Intraoperative/post operative data and long-term survivals were analyzed.Results Vascular occlusion time,operative time,intraoperative blood loss,intraoperative blood transfusion and hospital stay were (13.3 ± 9.1) min,(173.1 ±41.1)min,(548.7±320.5)ml,(511.4±231.7)ml and (18.6±8.8)d,respectively.Four patients developed major complications.There was no in-hospital death.The 1-,3-,and 5-year overall survival rates and disease-free survival rates were 71％,46％,29％ and 65％,40％,24％,respectively.Conclusions Mesohepatectomy for large and centrally located hepatocellular carcinoma preserved the maximum amount of functional liver parenchyma.It is safe and reliable and may be used as the treatment of choice.
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Surgical resection remains the only curative option of treatment for hepatocellular carcinoma,but centrally located tumors remain problematic.Extended right or left hepatectomy removes 60％ to 85％ of the hepatic parenchyma and is associated with more hepatic failure.Mesohepatectomy,resection of central hepatic segments (Couinaud's segments Ⅳ,Ⅴ,Ⅷ) and leaving the right and left segments in situ,preserves more functional hepatic tissues than extended hepatectomy.Despite its technical demands,mesohepatectomy should be considered as an alternative treatment for central huge hepatic tumors.
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Objective To summarize the initial experience in application of mesohepatectomy for the treatment of central liver tumors while focusing on its indication, short-term and long-term prognosis and especially outlining its technical details. Methods The clinical data of 3 patients receiving mesohepatectomy from December 2007 to March 2009 in our hospital were retrospectively analyzed.The imaging characteristics were summarized to convey the indication details. The technique details of the operation were outlined so as to reduce blood loss or other complications during and after the operation. The post-operative course and follow-up data were also collected and analyzed. Results Two patients suffered from primary hepatocellular carcinoma with liver cirrhosis and the other from giant hemangioma. The tumors were located in Couinaud yegment Ⅳ and/or Ⅷ. The average blood loss and operative duration were 800 ml and 7 h, respectively. Blood liver function tests returned to normal within 7 days postoperatively and the patients were discharged after that. No complications occurred. The follow-up for 7-15 months showed that there was no recurrence. Conclusion Mesohepatectomy is the principal choice of treatment for centrally located liver tumors. For the safety and avoidance of complications, the doctor should abide by the concept of segment-oriented hepatectomy and apply the updated techniques such as CUSA (Cavitron ultrasonic surgical aspirator). For patients with compromised liver function, mesohepatectomy might be superior to extended bepatectomy. Thus, the application of mesohepatectomy should be expanded. Meanwhile, further investigation is needed for its full evaluation.
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Objective To evaluate the safety and efficacy of mesohepatectomy for treating centrally located liver tumors. Methods The clinical data of 9 cases of centrally located liver tumor treated in our hospital with mesohepatectomy were retrospectively analyzed. Meanwhile, previous reports in Chinese and English on mesohepatectomy for treating centrally located liver tumors were reviewed.Results In the current series, perioperative mortality and morbidity rates were 0 and 66.6%, respectively. Eight patients were alive during a follow-up of 3-38 months. Twenty clinical trials were included in our systematic review. Four were retrospective non-randomized trials comparing central hepatectomy with lobar or extended hepatectomy. The surgical mortality rate of mesohepatectomy was 0% ～7. 4 %. Frequent complications were bile leakage (0. 4% ～ 18. 5 % ), pleural effusion (5. 7 % ～ 23.5 % ), ascites ( 1.9 % ～ 11.6 % ) and pneumonia ( 1.7 % ～ 12.5 % ). No differences in perioperative morbidity and early complication rate were found between the mesohepatectomy group and lobar or extended hepatectomy group in all four non-randomized studies. Two studies revealed that the overall survival rate and disease-free survival of patients with hepatocellular carcinoma were similar between the 2 groups. Conclusion Mesohepatectomy is a safe and effective operative procedure for the treatment of centrally located liver tumors.