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Background/Purpose: Since minimally invasive surgery has been incorporated in overall surgery, pure laparoscopic technology is involved in most hepatectomies, including right hepatectomy, in patients with hepatocellular carcinoma (HCC). However, its feasibility and safety in right hepatectomy are still controversial owing to the limited literature. This study aimed to compare the short- and longterm outcomes of pure laparoscopic right hepatectomy (PLRH) with those of open right hepatectomy (ORH) in patients with HCC. Methods: The prospectively collected medical records of 327 patients with HCC who underwent right hepatectomy between January 2010 and April 2020 at Seoul National University Hospital were retrospectively reviewed. We performed 1:1 propensity score matching between the PLRH and ORH groups. The primary end point was short-term outcomes, including hospital stay, blood loss, and morbidity; the secondary end point was long-term outcomes, including overall and recurrence- free survival. Results: Forty-nine patients were included in each group. Patients who underwent PLRH had a shorter postoperative hospital stay than those who underwent ORH (12.2 vs 8.9 days; P < .001). The requirement for blood transfusion was significantly lower in the PLRH group than in the ORH group (10.2% vs 2.0%; P = .010). The operative time (P = .479) and proportion of major complications (P = .487) were comparable between the groups. There were no significant differences in overall survival (P = .524) and the recurrence-free survival rate (P = .576) between the groups. Conclusions: Postoperative outcomes, including oncological outcomes, were comparable between PLRH and ORH, showing that PLRH can be a safe and feasible option to replace ORH in patients with HCC. [ABSTRACT FROM AUTHOR]

Background: Post-reperfusion syndrome (PRS) results in sudden hemodynamic instability following graft reperfusion. Although PRS is known to influence outcomes following liver transplantation, little is known regarding the effects of anesthetics on PRS. This study investigated the association between the type of anesthetic agent and PRS in liver transplantation. Methods: This single-center retrospective cohort study included patients who underwent liver transplantation between June 2016 and December 2019. Patients were divided into sevoflurane and propofol groups according to the anesthetic agent used. Stabilized inverse probability of treatment weighting (IPTW) analysis was performed to investigate the association between PRS identified based on blood pressure recordings and the type of anesthesia. Associations between the anesthetic agent and the duration of hypotension as well as early postoperative outcomes were also investigated. Results: Data were analyzed for 398 patients, 304 (76.4%) and 94 (23.6%) of whom were anesthetized with propofol and sevoflurane, respectively. PRS developed in 40.7% of the 398 patients. Following stabilized IPTW analysis, the association with PRS was lower in the sevoflurane group than in the propofol group (odds ratio, 0.47; P = 0.018). However, there was no association between the type of anesthetic used and early postoperative outcomes. Conclusions: The association of PRS was lower in the sevoflurane group than in the propofol group. However, there was no association between the type of anesthetic and the early postoperative outcomes. Further studies are required to determine the optimal anesthetic for liver transplantation. [ABSTRACT FROM AUTHOR]

Background: This study evaluated endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) as interventions for patients with anastomotic biliary complications (ABC) after living donor liver transplantation (LDLT). Methods: Prospectively collected data of patients who were diagnosed with ABC after LDLT between January 2013 and June 2017 were retrospectively reviewed. Results: There were 57 patients who underwent LDLT with a right liver graft using duct-to-duct biliary reconstruction and experienced ABC. Among the patients with RAD involvement, there were no significant differences in the intervention success (p = 0.271) and patency rates (p = 0.267) between ERCP and PTBD. Similarly, among the patients with RPD involvement, there were no significant differences in the intervention success (p = 0.148) and patency rates (p = 0.754) between the two procedures. Graft bile duct variation (p = 0.013) and a large angle between the recipient and graft bile duct (R-G angle) (p = 0.012) significantly increased the likelihood of failure of ERCP in the RAD. When the R-G angle was greater than 47.5°, the likelihood of ERCP failure increased. Conclusion: We recommend PTBD when graft bile duct variation is presented in patients with RAD involvement and/or when the R-G angle is greater than 47.5°. [ABSTRACT FROM AUTHOR]

Studies on effective immunosuppressive strategies for the management of patients undergoing a liver transplantation (LT) due to hepatocellular carcinoma (HCC) are limited. In the present study, immunosuppressive candidates predicted to exhibit beneficial immunosuppressive and tumor-suppressive effects in patients with HCC were assessed using Huh7 and HEP3B HCC cells, which have high proportions of CD133+EpCAM+ cancer stem cell (CSC) populations. The immunosuppressants assessed were sirolimus, tacrolimus, cyclosporine A and mycophenolate mofetil (MMF), and their activities were assessed on CSCs. Sirolimus and MMF reduced the proliferation of Huh7 and HEP3B cells; however, the proportion of CD133+EpCAM+ was notably increased in treated Huh7 cells. Sirolimus treatment alone resulted in G0-G1 cell cycle arrest at all doses in all Huh7 and CD133-EpCAM- populations; however, CD133+EpCAM+ populations showed only slight G1 arrest at higher doses only. In contrast, S-phase arrest was induced at all doses in the Huh7, CD133-EpCAM- and CD133+EpCAM+ populations by MMF. Sirolimus and MMF effectively reduced the proliferation of Huh7 and HEP3B cells, but did not exert a notable effect on the CD133+EpCAM+ cells. Therefore, therapeutic strategies utilizing Sirolimus and MMF should be further studied in vivo for regulation of CSC populations in order to reduce HCC recurrence rates. [ABSTRACT FROM AUTHOR]

Background/Aims Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the minimally invasive surgery era. However, the outcomes of pure laparoscopic donor left hepatectomy (PLDLH) are relatively less known than left lateral sectionectomy or right hepatectomy. The present study aimed to report the experience and outcomes of PLDLH including the middle hepatic vein and to compare them with conventional donor left hepatectomy (CDLH). Methods The medical records of live liver donors between January 2010 and January 2018 at Seoul National University Hospital were retrospectively reviewed. Donors who underwent left hepatectomy including the middle hepatic vein were included. To minimize selection bias, donors who underwent CDLH after the initiation of PLDH program were excluded. Subsequently, there were 18 donors who underwent CDLH and eight who underwent PLDLH. Results The warm ischemic time (4 minutes; interquartile range [IQR], 2 to 7 minutes vs 11 minutes; IQR, 10 to 16 minutes; p=0.001) was longer in the PLDLH group compared with CDLH group. The total operation time (265 minutes; IQR, 255 to 308 minutes vs 333 minutes [IQR 281-376 minutes]; p=0.090) and time to remove the liver (182 minutes; IQR, 172 to 205 minutes vs 245 minutes; IQR, 196 to 276 minutes; p=0.081) were also longer in PLDLH but not statistically significant. The length of postoperative hospital stay was significantly shorter in the PLDLH group (9 days; IQR, 8 to 10 days vs 7 days; IQR, 7 to 8 days; p=0.006). There was no postoperative complication in PLDLH group. The rate of complications in recipients was similar in both groups. Conclusions PLDLH including the middle hepatic vein appears to be safe and feasible. Further analysis including long-term outcome is needed. [ABSTRACT FROM AUTHOR]

Background/Aims Pure laparoscopic donor right hepatectomy (PLDRH) has been reported as a safe and feasible approach. However, its outcomes have not yet been evaluated in a large comparative study. The aim of this study is to describe our experience with PLDRH and to compare its outcomes with those of open right hepatectomy in live liver donors using propensity score matching. Methods The medical records of live liver donors between January 2010 and September 2018 at Seoul National University Hospital were retrospectively reviewed. Donors who underwent hepatectomy other than conventional open right hepatectomy or PLDRH were excluded. Propensity score matching study was conducted. Subsequently, 198 donors were included in each group. Results The total operation time (270.8 vs 289.9, p<0.001), time to remove the liver (166.2 vs 211.4, p<0.001), and warm ischemic time (3.7 vs 12.3, p<0.001) were longer in the PLDRH group. The percentage of getting multiple bile duct openings was higher in the PLDRH group (44.9% vs 56.1%, p=0.027). ΔHemoglobin (Hb)%, calculated as ΔHb%= [(preoperative Hb−postoperative Hb)/preoperative Hb]x100, was lower (21.3% vs 16.6%, p<0.001) and Δaspartate aminotransferase (AST)%, calculated as ΔAST%=[(postoperative AST−preoperative AST)/preoperative AST]x100 (783.8% vs 1,136.9%, p<0.001), and Δalanine aminotransferase (ALT)%, calculated as ΔALT%=[(postoperative ALT−preoperative ALT)/preoperative ALT]x100 (912.7% vs 1,358.1, p<0.001), were higher in the PLDRH group. The length of postoperative hospital stay was significantly shorter in the PLDRH group (8.6 days vs 7.5 days, p<0.001). However, the rate of complications was similar in both groups (10.6% vs 6.1%, p=0.102). Conclusions PLDRH is safe and feasible when performed at an experienced LDLT center. [ABSTRACT FROM AUTHOR]