Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma

Tamoto, Eiji; Hirano, Satoshi; Tsuchikawa, Takahiro; Tanaka, Eiichi; Miyamoto, Masaki; Matsumoto, Joe; Kato, Kentaro; Shichinohe, Toshiaki

doi:10.1111/hpb.12067

Cited by 55 publications

(62 citation statements)

References 12 publications

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“…No differences in morbidity rates were observed in most of the published studies (17)(18)(19)(20)(21)(22)25,(27)(28)(29)46), as it was the case in the present series. Only one study showed significantly increased morbidity rates when a PVR is performed (23).…”

Section: Discussionsupporting

confidence: 62%

“…Thus, few surgical centers propose the routine en-bloc PVR ("notouch" technique) (7,20,22,(44)(45)(46), while most of the surgical teams recommend the selective use of the PVR (2,5,6,11,15,18,21,23,25,28, 29,43), only when the preoperative imaging or intraoperative exploration suspect portal vein invasion by the tumor (8), as in was the case in the present series. A recent systematic review and meta-analysis have shown that the sensitivity and specificity of a preoperative contrastenhanced computed tomography in detecting a portal vein invasion in a PHC patient are 89% and 92%, respectively (47).…”

Section: Discussionmentioning

confidence: 75%

“…Previous studies did not identify any significant differences of operative time and blood loss between the patients with and without a PVR for PHC (17,22,23,26,46). However, Wang and co-workers identify significantly increased blood loss when a PVR is performed (28).…”

Section: Discussionmentioning

confidence: 92%

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Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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Introducere: Siguranţa rezecţiei de venă portă în chirurgia colangiocarcinoamelor perihilare a fost deja dovedită în Asia, America şi Europa de Vest. Totuşi, nu există nici un fel de date referitoare la acest subiect, care să provină din Europa de Est. Scopul studiului este de a evalua comparativ rezultatele postoperatorii imediate şi pe termen lung după rezecţia cholangiocarcinoamelor perihilare, cu şi fără rezecţie de venă portă. Pacienţi şi metode: Datele a 21 de pacienţi rezecaţi pentru colangiocarcinoame perihilare ce au asociat rezecţia venei porte au fost comparate cu datele a 102 pacienţi fără rezecţie de venă portă. Pentru analiza comparativă a datelor din cele două grupuri s-au folosit teste statistice specifice. Rezultate: Rezecţia venei porte a fost realizată la 17% dintre pacienţi. În grupul pacienţilor cu rezecţie asociată de venă portă au fost realizate semnificativ mai multe trisecţionectomii drepte (p = 0.031) şi rezecţii de lob caudat (p = 0.049). Ca urmare, atât timpul operator (p = 0.015) cât şi pierderea de sânge intraoperator (p = 0.002) au fost semnificativ mai mari în acest grup de pacienţi cu rezecţie de venă portă. Nu s-au constatat diferenţe semnificative între cele două grupuri de pacienţi în ceea ce priveşte rata complicaţiilor severe postoperatorii, mortalitatea postoperatorie şi chimioterapia adjuvantă. Totuşi, în grupul pacienţilor cu rezecţie de venă portă, rata insuficenţei hepatice postoperatorii cu impact clinic

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 75%

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Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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“…Prophylactic or pre‐emptive resection of the major vessels for patients without vascular invasion is not recommended because vascular resection/reconstruction yields a substantial risk of vascular thrombosis or obstruction, and a survival benefit of prophylactic vascular resection has never been demonstrated .…”

Section: Indications For Vascular Resectionmentioning

confidence: 99%

“…Because radiologic imaging may underestimate or overestimate the vascular invasion of the tumor, the dissection of the artery suspected of invasion should be attempted from the remote tumorfree site. Prophylactic or pre-emptive resection of the major vessels for patients without vascular invasion [2,17] is not recommended because vascular resection/reconstruction yields a substantial risk of vascular thrombosis or obstruction, and a survival benefit of prophylactic vascular resection has never been demonstrated [18].…”

Section: Indications For Vascular Resectionmentioning

confidence: 99%

Surgical technique of hepatectomy combined with simultaneous resection of hepatic artery and portal vein for perihilar cholangiocarcinoma (with video)

Ito

Yokoyama

Igami

et al. 2014

J Hepato Biliary Pancreat

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Perihilar cholangiocarcinomas often involve the bifurcation of the portal vein and the hepatic artery at initial presentation. Previously, vascular invasion was a major obstacle for R0 resection; therefore, such tumors were regarded as locally advanced, unresectable disease. Recently, in leading centers, these tumors have been resected using a specific technique, vascular resection and reconstruction. Vascular resection is classified into three types: portal vein resection alone, hepatic artery resection alone, and simultaneous resection of both the portal vein and hepatic artery. Of these, portal vein resection is widely performed, whereas hepatic artery resection remains controversial. Therefore, hepatectomy combined with simultaneous resection of the portal vein and hepatic artery represents one of the most complicated and challenging procedures in hepatobiliary surgery. The survival benefit of this extended procedure remains unproven, and there is only a single study reporting an unexpectedly favorable outcome in 50 patients. Considering the dismal survival in patients with unresectable disease, hepatic artery resection and/or portal vein resection may be a promising option of choice. However, the technique is highly demanding and has not been standardized. Therefore, this extended surgery may be allowed only in selected hepatobiliary centers.

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Influence of biliary and vascular resection types on morbidity in hepatectomies with vascular involvement

Silva,

Diniz,

Torres

et al. 2024

Journal of Surgical Oncology

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IntroductionHepatectomies associated with vascular resections pose a technical challenge for surgeons, involving multiple reconstruction techniques. Moreover, adding clinical and surgical risks in the postoperative setting of these complex procedures are mainly due to prolonged surgical periods and potential complications inherent to vascular manipulation. Leveraging the expertise of a Cancer Center, we propose an institutional assessment utilizing the case series from A. C. Camargo Cancer Center in hepatectomies associated with vascular resection, evaluating postoperative complications and outcomes while highlighting clinical, laboratory, pathological, and surgical factors that may influence results.ObjectiveTo assess mortality and morbidity associated with hepatectomies involving vascular resection.Materials and MethodsFrom a prospective database, a study was performed evaluating postoperative survival and morbidity using scoring systems such as Clavien−Dindo through a cohort analysis.ResultsFrom a total of 1021 liver resections for a period of 10 years, 31 cases were evaluated from a unique cancer center in Brazil! Factors such as the performance of major hepatectomies, the need for blood transfusion, and the administration of neoadjuvant or adjuvant systemic therapy did not appear to influence the outcome of morbidity or mortality. However, the resection of the associated bile duct and the type of vascular resection seemed to influence morbidity outcomes with statistical significance (p = 0.006+ …).ConclusionHepatectomies associated with vascular resections are safe in selected cases and when performed in referral centers. Factors such as associated bile duct resection and type of vascular resection should be considered for procedure indication.

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Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma

Abstract: A portal vein resection using the no-touch technique with a right-sided hepatectomy had a positive impact on survival and is feasible in terms of long-term outcomes with acceptable mortality.

Cited by 55 publications

References 12 publications

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Surgical technique of hepatectomy combined with simultaneous resection of hepatic artery and portal vein for perihilar cholangiocarcinoma (with video)

Influence of biliary and vascular resection types on morbidity in hepatectomies with vascular involvement

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