At automated CT volumetry in live liver donors, the percentage blood volume varies. The V(BFree) is more accurate than is V(BFill)/1.22 in estimation of hepatic weight.

Backgrounds/AimsFrequently encountered in practice, the first-line treatment for acute cholecystitis is early or urgent cholecystectomy, with laparoscopic cholecystectomy (LC) being the preferred method. Percutaneous transhepatic gallbladder drainage (PTGBD) is considered as a safe alternative therapeutic option for resolving acute cholecystitis in surgically high-risk patients. We evaluated the surgical outcomes of acute cholecystitis, focusing on the differences between emergent LC without PTGBD, and scheduled LC following PTGBD.MethodsBetween March 2010 and December 2014, 294 patients with acute cholecystitis who had undergone LC, were retrospectively studied. Group I included 166 patients who underwent emergency LC without PTGBD. Group II included 128 patients who underwent scheduled LC after PTGBD. Clinical outcomes were analyzed according to each group.ResultsOn admission, Group II had a higher mean level of c-reactive protein than Group I. According to the classification of the American Society of Anesthesiologists (ASA), group II had a greater number of high-risk patients than group I. There was no significant difference on perioperative outcomes between the two groups, including open conversion rate and complications. Analysis as per the ASA classes revealed no statistically remarkable finding between the groups.ConclusionsThere are no significant differences in the surgical outcomes of emergency LC group without PTGBD, and scheduled LC group following PTGBD. Comparison between two groups according to ASA classification reflecting the comorbidity and severity of condition of the patients also revealed no significant differences. However, scheduled LC following PTGBD is important for patients having acute cholecystitis with concurrent comorbidity.

Background: The clinical implication of lymph node (LN) dissection of intrahepatic cholangiocarcinoma (ICCA) is still controversial, and LN metastasis (LNM) based on tumor site has not been confirmed yet. Methods: Patients who underwent curative-intent surgery at 10 tertiary referral centers were identified and divided into peripheral (PP) and near second confluence level tumor (NC) groups on the basis of the distance from the second confluence and oncological outcomes were compared. Results: Of 179 patients, 121 patients with LND were divided into the NC (n ¼ 89) and PP groups (n ¼ 32) on the basis of 4.5 cm from the second confluence. NC group showed higher LNM rate than PP group (46.1 vs 21.9%, p ¼ 0.016) and NC was a risk factor for LNM (odds ratio: 4.367; 95% confidence interval: 1.234e15.453, p ¼ 0.022). The 5-year overall survival (OS) rate (38.0% vs. 27.8%, p ¼ 0.777) and recurrence-free survival (RFS) rates (22.8% vs. 25.8%, p ¼ 0.742) showed no differences between the PP and NC groups. In the NC group, N1 patients showed worse 5-year OS (12.7% vs 39.0%, p ¼ 0.004) and RFS (8.8% vs 28.6%, p ¼ 0.004) than the N0 patients. In the PP group, discordant results in 5-year OS (48.9% vs. 50.0%, p ¼ 0.462) and RFS (41.3% vs. 0%, p ¼ 0.056) were found between the N0 and N1 patients. Conclusion:The NC group was an independent risk factor for LNM and LNM worsened prognosis in NC group for ICCA. In the PP group, LND should not be omitted because of high LNM rate and insufficient oncologic evidence.

Purpose: Hepatic resection and liver transplantation are considered a curative treatment for hepatocellular carcinoma (HCC) within the Milan criteria. In this study, we examine the outcome of hepatic resection for HCC within the Milan criteria, and determine the effectiveness of hepatic resection as the primary treatment for HCC within the Milan criteria in Child-Pugh class A.

Purpose:The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, which is one of the most important innovations in the field of major hepatic resections. This study was conducted to review tumors' profiles after applying this procedure and to evaluate the usefulness of LHM and Glissonean pedicle transaction method (GPTM). Methods: Medical records of 64 patients who underwent hepatic resection using LHM and GPTM at the Asan Medical Center were reviewed. The classic LHM was conducted according to the Belghiti method. Results: Among 64 patients, 46 patients had hepatocellular carcinoma; 7, intrahpatic cholangiocarcinoma; 4, hilar cholangiocarcinoma; 4, metastatic liver cancer; 3, benign liver tumor. Mean tumor size was 10.6 cm (3∼22). Mean liver parenchymal transection time was 20 min (15∼30). Right side hepatectomy was performed in 44 patients; left side hepatectomy with or without caudate lobe was performed in 19 patients. Twenty patients (31.3%) required blood transfusion during surgery. There was no in-hospital mortality or major complications. Minor complications developed in 6 patients (9.37%). Conclusion: GPTM and LHM are a safe and useful surgical application of various anatomical resections for huge liver tumor and an effective procedure during left hepatectomy with or without caudate lobe. (J Korean Surg Soc 2010;79:122-129)