Recent advances in hepatic resection

DeMatteo, Ronald P.; Fong, Yuman; Jarnagin, William R.; Blumgart, Leslie H.

doi:10.1002/1098-2388(200009)19:2<200::aid-ssu11>3.0.co;2-m

Cited by 74 publications

(45 citation statements)

References 25 publications

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“…[4][5][6][7][8][9] Improvements in surgical techniques and per-operative management increase the number of repeat hepatic resection in patients with isolated hepatic recurrence. 20 A reduction of blood loss, which is associated with preoperative morbidity and mortality, was obtained over the past decade with a corresponding decrease of transfusion requirements. This was related to an increase in parenchymal-sparing resection, performing of resections with a low central venous pressure, and with the advent of portal pedicle ligation maneuvers.…”

Section: Discussionmentioning

confidence: 99%

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Pool

Lalmahomed

Wilt

et al. 2009

Journal of Gastrointestinal Surgery

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Objective The objective of the study was to identify patients who may benefit from local treatment in recurrent colorectal liver metastases. Materials and methods A total of 51 consecutive patients were treated for hepatic recurrence(s) after an initial partial hepatic resection. Surgery was considered as the primary treatment option for eligible patients. Patients with a small liver remnant after major hepatectomy were treated with radiofrequency ablation (RFA) or stereotactic body radiation therapy (SRx). SRx was given as an outpatient, emerging local treatment option for patients with intra-hepatic recurrences not eligible for surgery or RFA. Partial liver resection was performed in 36 patients (70%), RFA in ten patients (20%), and SRx in five patients (10%). Results Median hospital stay was 7 (range, 3-62) days with a morbidity of 16% without in-hospital death. None of the patients received adjuvant chemotherapy. There was no difference in recurrence or survival between the three treatment modalities. Overall 5-year survival was 35% with an estimated median survival of 37 months. Patients with a disease-free interval between first hepatectomy and hepatic recurrence less than 6 months did not survive 3 years. Conclusions Resection, RFA, and SRx can be performed safely in patients with recurrent colorectal liver metastases and offer a survival that seems comparable to primary liver resections of colorectal liver metastases.

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Section: Discussionmentioning

confidence: 99%

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Pool

Lalmahomed

Wilt

et al. 2009

Journal of Gastrointestinal Surgery

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“…Complications relating to biliary tree following RF ablation are described in the literature [12] . Such complications remain to be the main problem with major resections using RF and regardless of the ultimate advantageous function of a bloodless RF device the liver surgical principles of hilar dissection should not be overlooked.…”

Section: Discussionmentioning

confidence: 99%

“…Recent efforts have aimed to perform bloodless liver resections in the setting of parenchymal transection with new sophisticated devices [9][10][11][12][13][14] avoiding inflow occlusion. The Cool-tip radiofrequency device (Radionics, Tyco Healthcare) and the Tissue Link equivalent both use radiofrequency energy transmitted through the electrode to the adjacent liver parenchyma causing ion vibration with heat production.…”

Section: In Liver Resectionmentioning

confidence: 99%

Current role of bloodless liver resection

Delis

Madariaga²,

Bakoyiannis

et al. 2007

WJG

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Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. Recently new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this article is to address the issue of bloodless liver resection using radiofrequency energy. Radionics, Cool-tip TM System and Tissue Link are some of the devices which are using radiofrequency energy. All information included in this article, refers to these devices in which we have personal experience in our unit of liver surgery. These devices take advantage of its unique combination of radiofrequency current and internal electrode cooling to perform sealing of the small vessels and biliary radicals. Dissection is also feasible with the cool-tip probe. For the purposes of this study patient sex, age, type of disease and type of surgical procedure in association with the duration of parenchymal transection, blood loss, length of hospital stay, morbidity and mortality were analyzed. Cool-tip RF device may provide a unique, simple and rather safe method of bloodless liver resections if used properly. It is indicated mostly in cirrhotic patients with challenging hepatectomies (segment Ⅷ, central resections). The total operative time is eliminated and the average blood loss is significantly decreased. It is important to note that this technique should not be applied near the hilum or the vena cava to avoid damage of these structures.

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“…Bleeding from hepatic veins can be minimized by maintaining low central venous pressure (CVP) during open hepatectomy 39, 40. Although there is a risk of air embolism caused by absorption of air into the vena cava through the branches of the hepatic veins,41 the incidence of clinically significant air embolism is low, and lower CVP is commonly used during open hepatectomy 42.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

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Recent advances in hepatic resection

Cited by 74 publications

References 25 publications

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Current role of bloodless liver resection

Evolution and revolution of laparoscopic liver resection in Japan

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