Treatment of centrally located hepatocellular carcinoma with central hepatectomy

Hu, Rey‐Heng; Lee, Po‐Huang; Chang, Yue‐Cune; Ho, Ming‐Chih; Yu, Shan–Chi

doi:10.1067/msy.2003.102

Cited by 74 publications

(93 citation statements)

References 23 publications

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“…These include a longer operating time, greater intraoperative blood loss, higher risk of biliary and vascular complications, all mainly attributed to the proximity to the hilar structures and the presence of 2 significant resection planes instead of a single plane. Despite this, previous reports showed that CH is safe and achieves comparable complication rates and overall survival rates as conventional major hepatectomies but harbors the advantages of: (1) preserving liver parenchyma with the aim of decreasing the risk of postoperative liver failure; (2) no proven oncological compromises as long as margins are negative and adequate; and (3) increases the opportunity for future repeat resection, if warranted, in cases of recurrent malignancies such as colorectal or neuroendocrine liver metastases [7,8,22,23,25] . The current literature directly comparing patients undergoing extended hemi-hepatectomy and CH is lacking [9,15,17,23,25] .…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, previous reports showed that CH is safe and achieves comparable complication rates and overall survival rates as conventional major hepatectomies but harbors the advantages of: (1) preserving liver parenchyma with the aim of decreasing the risk of postoperative liver failure; (2) no proven oncological compromises as long as margins are negative and adequate; and (3) increases the opportunity for future repeat resection, if warranted, in cases of recurrent malignancies such as colorectal or neuroendocrine liver metastases [7,8,22,23,25] . The current literature directly comparing patients undergoing extended hemi-hepatectomy and CH is lacking [9,15,17,23,25] . There is only one study in the current literature with more than 100 patients (Table 1) [3,[7][8][9][17][18][19][20]22,23,25,[27][28][29][30][31][32][33][34][35][36][37] .…”

Section: Introductionmentioning

confidence: 99%

“…Central hepatectomy (CH), also known as mesohepatectomy, was first performed for gallbladder cancer in 1972 and is used to describe the operative procedure to resect segments 4, 5, 8 ± 1 ( Figure 1) [15][16][17][18][19][20] . Other synonymous terms used in the literature include central hepatic resection, middle hepatectomy, middle hepatic lobectomy, central bisegmentectomy and central bisectionectomy [20][21][22][23][24][25][26][27] . Regardless of the technical term used, the principle behind this procedure is the same and was not commonly carried out till more recently.…”

Section: Introductionmentioning

confidence: 99%

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Central hepatectomy for centrally located malignant liver tumors: A systematic review

Lee¹

2014

WJH

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AIM:To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not. METHODS:A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy. RESULTS:A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle's maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION:Based on current literature, CH is a promising option for anatomical parenchymal-preserving procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Central hepatectomy for centrally located malignant liver tumors: A systematic review

Lee¹

2014

WJH

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“…5,6 Improvements in the understanding of liver anatomy and advancements in image technology have contributed to the development of segmental liver resection. 7 The ICGR 15 is useful for predicting the safe limit of liver resection in each patient, and liver volumetry using computed tomography is helpful for evaluating whether the [8][9][10] Preserving more liver parenchyma decreases morbidity and mortality rates 11 and increases the possibility of the second hepatic resection in the case of a recurrent intrahepatic tumor. 12 However, more extensive dissection of vascular pedicles and larger resection surfaces of liver parenchyma in CBS may result in excessive blood loss, longer duration of operation, or greater incidence of postoperative bile leakage, 8,13,14 and CBS has not been frequently used for treatment of centrally located liver tumors.…”

Section: Discussionmentioning

confidence: 99%

Central Bisegmentectomy for Malignant Liver Tumors: Experience in 8 Patients

Shiba

Haruki

Futagawa

et al. 2014

International Surgery

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Central bisegmentectomy (CBS) of the liver is an en bloc hepatic resection of Couiaud segments 4, 5, and 8. The indications for CBS include benign and malignant tumors occupying both the left medial and right anterior segments. However, CBS has rarely been reported. Here, we investigate CBS in patients with suboptimal liver function for whom an extended lobectomy is not an optimal solution. Each case was 1 of 8 patients who underwent CBS for hepatocellular carcinoma (HCC) or colorectal cancer liver metastasis (CRLM) at the Department of Surgery, Jikei University Hospital. Indications for CBS consisted of CRLM in 3 patients and HCC in 5 patients. The median duration of operation was 552 minutes, and median blood loss was 2263 g. No postoperative nor inhospital mortalities occurred. In this study, 1-, 2-, and 3-year disease-free survival rates were 62.5%, 12.5%, and 12.5%, respectively, and 1-, 2-, and 3-year overall survival rates were 100%, 100%, and 85.7%, respectively. CBS is advocated for central liver tumors in patients with suboptimal liver function for whom extended lobectomy could result in less than optimal remnant liver volume and function.

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“…Centrally located hepatocellular carcinoma (HCC) is defined as HCC closely adjacent to the central hepatic segments, including Couinaud's segments IVa, IVb, V and VIII, without usually including malignancies within the caudate lobe (1). Centrally located HCC is adjacent to the portal vein, bile duct, hepatic vein and inferior vena cava.…”

Section: Introductionmentioning

confidence: 99%

Mesohepatectomy for the treatment of patients with centrally located hepatocellular carcinoma

Zuo

Qiu

Ouyang

et al. 2014

Molecular and Clinical Oncology

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Abstract. Mesohepatectomy is considered a feasible option for patients with centrally located hepatocellular carcinoma (HCC). However, mesohepatectomy is a technically demanding and less frequently used procedure. In this study, we summarized the surgical experience and evaluated the clinical outcomes of mesohepatectomy in 24 patients with centrally located HCC. Of these patients, 9 were treated with hepatectomy of Couinaud's segments IV, V and VIII with concurrent cholecystectomy; 8 underwent resection of segments IVb, V and VIII, including 7 patients who also received a cholecystectomy; 4 underwent hepatectomy of segments IVa, V and VIII; and 3 patients were treated with hepatectomy of segments I, IV, V and VIII, with concurrent cholecystectomy. The Pringle maneuver was used on 17 patients during hepatectomy. Total hepatic vascular exclusion (HVE) was performed on 3 patients and HVE was not used on 4 patients. The average mesohepatectomy operative time was 238 min and the average intraoperative blood loss was 480 ml (200-2,200 ml). There was no intraoperative mortality and the postoperative morbidity rate was 25% (6/24). The 1-and 3-year overall survival rates were 76 and 46%, respectively. Therefore, mesohepatectomy is a safe and effective surgical procedure for the treatment of centrally located HCC and HVE during mesohepatectomy for centrally located HCC is crucial to the success of the operation and postoperative patient recovery. IntroductionCentrally located hepatocellular carcinoma (HCC) is defined as HCC closely adjacent to the central hepatic segments, including Couinaud's segments IVa, IVb, V and VIII, without usually including malignancies within the caudate lobe (1). Centrally located HCC is adjacent to the portal vein, bile duct, hepatic vein and inferior vena cava. Due to the close proximity to these major vessels, the treatment of such cancers remains challenging. Radiofrequency ablation (RFA) and percutaneous ethanol injection are less effective for larger (>5 cm) compared to smaller tumors (2-4). Centrally located HCC had long been considered unsuitable for surgical resection and the traditional treatment for such cancers included an extended right or left hepatectomy (5-7). However, extended hepatectomy is associated with higher morbidity and mortality, mainly due to the increased risk of postoperative liver failure (8,9).Over the last few years, with the advancement in the surgical techniques for liver cancer, mesohepatectomy has become a feasible option for patients with centrally located HCC, particularly for those with post-hepatitis cirrhosis. Previous clinical studies demonstrated that mesohepatectomy may be superior to extended hepatectomy, as it reduces the volume of the resected liver (10,11). However, mesohepatectomy is a technically demanding procedure and may cause injuries to blood vessels and bile ducts, resulting in increased blood loss; therefore, it is less frequently used (11,12) and the application of mesohepatectomy in the treatment of centrally located tumors has not been...

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Treatment of centrally located hepatocellular carcinoma with central hepatectomy

Cited by 74 publications

References 23 publications

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Central hepatectomy for centrally located malignant liver tumors: A systematic review

Central Bisegmentectomy for Malignant Liver Tumors: Experience in 8 Patients

Mesohepatectomy for the treatment of patients with centrally located hepatocellular carcinoma

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