Association of Remnant Liver Ischemia With Early Recurrence and Poor Survival After Liver Resection in Patients With Hepatocellular Carcinoma

Cho, Jai Young; Han, Ho Seong; Choi, Young Rok; Yoon, Yoo Seok; Kim, Sungho; Choi, Jihye; Jang, Jae Seong; Kwon, Sun U.; Kim, Haeryoung

doi:10.1001/jamasurg.2016.5040

Cited by 82 publications

(63 citation statements)

References 38 publications

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“…31,32 Some evidence shows that clamping is not insignificant. Cho et al 33 showed that the use of the Pringle maneuver and longer operative times were independent risk factors for severe remnant liver ischemia. Hao et al 34 suggested that intermittent portal clamping is an independent risk factor for poor long-term postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

Garnier

Marchese

Meillat

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

Garnier

Marchese

Meillat

et al. 2018

HPB

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“…There are multiple risk factors for recurrence after HCC resection. In a prior report, the host factors for recurrence included hepatitis B or C; the tumor factors included vascular invasion, satellite nodule, tumor size, and advanced tumor stage; and surgical factors included the extent of resection, RM, perioperative transfusion, remnant liver ischemia after surgery, and postoperative complications [4, 20]. …”

Section: Discussionmentioning

confidence: 99%

Correlation between Resection Margin and Disease Recurrence with a Restricted Cubic Spline Model in Patients with Resected Hepatocellular Carcinoma

et al. 2018

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Background: The relationship between resection margin (RM) and recurrence of resected hepatocellular carcinoma (HCC) is unclear. Methods: We reviewed clinical data for 419 patients with HCC. The oncologic outcomes were compared between 2 groups of patients classified according to the inflexion point of the restricted cubic spline plot. Results: The patients were divided according to an RM of <1 cm (n = 233; narrow RM group) or ≥1 cm (n = 186; wide RM group). The 5-year recurrence-free survival (RFS) rate was lower (34.8 vs. 43.8%, p = 0.042) and recurrence near the resection site was more frequent (4.7 vs. 0%, p = 0.010) in the narrow RM group. Patients with multiple lesions, or prior transarterial chemoembolization (TACE) or radiofrequency ablation (RFA) were excluded from subgroup analyses. In patients with a 2–5 cm HCC, the 5-year RFS was greater in the wide RM group (54.4 vs. 32.5%, p = 0.036). Narrow RM (hazard ratio 1.750, 95% CI 1.029–2.976, p = 0.039) was independently associated with disease recurrence. Conclusion: In patients with a single 2–5 cm HCC without prior TACE/RFA, an RM of ≥1 cm was associated with lower risk of recurrence after liver resection.

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“…Pringle was the first to advocate ligating the inflow vessels of the liver during transection of the parenchyma for bleeding reduction [ 17 , 18 ]. While ischemic damage is a major problem [ 19 , 20 ], ligation and division of the corresponding vessels and ducts via dissection of the hepatic hilus for blood loss reduction during hepatic parenchyma transection when performing right hepatectomy were first described by Lortat-Jacobs and Robert in 1952, which were known as anatomical hepatectomy or classical hepatectomy later [ 21 ]. However, the risk of hemorrhage during dissection and bile leaks occurring in the postoperative period makes this approach not suitable for laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic liver hanging maneuver through the retrohepatic tunnel on the right side of the inferior vena cava combined with a simple vascular occlusion technique for laparoscopic right hemihepatectomy

et al. 2017

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BackgroundLaparoscopic hepatectomy has been performed in many hospitals, with the development of the laparoscopic operation technique. However, performing complex laparoscopic hepatectomy, such as right hemihepatectomy, is still a challenge. The aim of this study was to describe the application of a simple vascular occlusion technique and new liver hanging maneuver (LHM) in complex laparoscopic hepatectomy, which are both advocated by Chen Xiaoping for open hepatectomy.MethodsThe clinical data of 29 consecutive patients who underwent laparoscopic right hemihepatectomy (LRH) from October 2014 to October 2016 were retrospectively analyzed. During operation, the vascular occlusion technique without hilus dissection and LHM through the retrohepatic avascular tunnel on the right side of the inferior vena cava were used.ResultAll 29 operations were successfully performed laparoscopically, while adopting Chen’s methods. The study consisted of 23 patients with hepatocellular carcinoma, four patients with intrahepatic cholangiocarcinoma, and two patients with hepatic metastasis of colonic carcinoma. The tumor size was 12.4 ± 1.9 cm. The operation time of LRH was 190.3 ± 49.9 min. The intraoperative blood loss of LRH was 281.7 ± 117.8 mL; five patients required blood transfusion, and the amount of blood transfusion was 300.0 ± 89.4 mL. No case was converted to open surgery, and no death occurred. All resulted in R0 resections. The median free margin was 20.1 ± 10.8 mm. The time of postoperative oral diet intake was 2.10 ± 0.96 days. The complication rate was 17.2%. The average hospital stay after operation was 10.0 ± 2.9 days.ConclusionComplex hepatectomy is a bloodless procedure that can be performed under a laparoscope safely using Chen’s methods of vascular occlusion technique and LHM.

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Association of Remnant Liver Ischemia With Early Recurrence and Poor Survival After Liver Resection in Patients With Hepatocellular Carcinoma

Abstract: Preventive management and technical refinements in hepatectomy are important to decrease the risk of RLI and to improve survival of patients with hepatocellular carcinoma.

Cited by 82 publications

References 38 publications

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

Correlation between Resection Margin and Disease Recurrence with a Restricted Cubic Spline Model in Patients with Resected Hepatocellular Carcinoma

Laparoscopic liver hanging maneuver through the retrohepatic tunnel on the right side of the inferior vena cava combined with a simple vascular occlusion technique for laparoscopic right hemihepatectomy

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