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Introduction: Survival comparisons among patients with liver metastases from pancreatic and rectal neuroendocrine tumors (NETs) were limited, and the efficacy of observation rules in patients undergoing hepatectomy for neuroendocrine liver metastases (NELMs) was unknown. This study aims to distinguish these characteristics and clarify the effects of the observation rules on NELMs., Methods: Clinical data were separately collected from patients with pancreatic and rectal NELMs at medical centers in both Japan and China. The Japanese cohort followed the observation rules for the resection of NELMs. A comparative analysis was conducted on clinical characteristics and prognosis features such as overall survival time (OS) and disease-free survival interval (DFS-I)., Results: Enrollment included 47 and 34 patients from Japan and China, respectively. Of these, 69 and 12 patients had tumors originating from the pancreas and rectum, respectively. The OS time in patients undergoing primary tumor resection was significantly longer; however, the OS time between the patients undergoing and not undergoing radical resection of liver metastasis was the same. In asynchronous NELMs, patients with rectal (R)-NELMs showed a significantly higher proportion of type III NELMs. Additionally, the median DFS-I of asynchronous R-NELMs was longer than the recommended follow-up time, with 71.4% of them classified as G2. In the Japanese cohort, patients who adhered to the observation rules exhibited a longer median DFS after hepatectomy for NELMs compared with their counterparts., Conclusion: Although curative surgery is crucial for primary lesions, personalized approaches are required to manage NELMs. Extended overall follow-ups and shortened follow-up intervals are recommended for G2 stage rectal NETs. The observation rules for NELMs require further validation with a larger sample size., (© 2024. The Author(s).)

Background: Post-hepatectomy liver failure (PHLF) is a serious complication after major hepatectomy with extrahepatic bile duct resection (Hx with EBDR) that may cause severe morbidity and even death. The purpose of this study was to compare several criteria systems as predictors of PHLF-related mortality following Hx with EBDR for perihilar cholangiocarcinoma (PHCC)., Methods: The study cohort consisted of 222 patients who underwent Hx with EBDR for PHCC. We compared several criteria systems, including previously established criteria (the International Study Group of Liver Surgery (ISGLS) criterion; and the "50-50" criterion), and our institution's novel systems "Max T-Bili" defined as total bilirubin (T-Bili) >7.3 mg/dL during post-operative days (POD) 1-7, and the "3-4-50" criterion, defined as total bilirubin >4 mg/dL and prothrombin time <50% on POD #3., Results: Thirteen patients (5.8%) died from PHLF-related causes. The 3-4-50 criterion showed high positive predictive values (39.1%), the 3-4-50, Max T-Bili, and 50-50 criterion showed high accuracies (91.7, 86.9, and 90.5%, respectively) and varying sensitivities (69.2, 69.2, and 38.5% respectively)., Conclusions: The 3-4-50, Max T-Bili, and 50-50 criterion were all useful for predicting PHLF-related mortality after Hx with EBDR for PHCC., (© 2018 S. Karger AG, Basel.)

Background: The Comprehensive Complication Index (CCI) is a new tool to evaluate the postoperative condition by calculating the sum of all complications weighted by their severity. The aim of this study was to identify independent risk factors for a high CCI score (≥40) in 229 patients after major hepatectomies with biliary reconstruction for biliary cancers., Methods: The CCI was calculated online via www.assessurgery.com. Independent risk factors were identified by multivariable analysis., Results: 57 (25%) patients were classified as having CCI ≥ 40. On multivariable analysis, volume of intraoperative blood loss (≥2.5 L) (p = 0.004) and combined pancreatoduodenectomy (PD) (p = 0.006) were independent risk factors for CCI ≥ 40. A high level of maximum serum total bilirubin was identified as independent risk factors for a high volume of intraoperative blood loss. Liver failure (p = 0.046) was more frequent in patients with combined PD than in those without., Discussion: Patients who undergo preoperative external biliary drainage for severe jaundice might have impaired production of coagulation factors. When blood loss during liver transection becomes difficult to control, surgeons should consider various strategies, such as second-stage biliary or pancreatic reconstruction. In patients planned to undergo major hepatectomy with combined PD, preoperative portal vein embolization is mandatory to prevent postoperative liver failure., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Background: Whether concomitant hepatic artery resection (HAR) improves the prognosis for advanced perihilar cholangiocarcinoma remains controversial. The aim of the present study was to compare short- and long-term surgical results of HAR versus standard resection (SR) for perihilar cholangiocarcinoma using propensity score matching., Methods: Among 209 patients with perihilar cholangiocarcinoma patients who underwent resection in our department, 28 patients underwent HAR, and the remaining 181 patients underwent SR. To adjust for differences in clinicopathological factors, including difficulty in surgery, between groups, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 24 patients per group. The study protocols were approved by our institutional review board (015-0365), enrolled in UMIN-CTR (No: UMIN000019927), and conducted according to the Declaration of Helsinki., Results: No significant differences were seen in overall incidence of postoperative complications (Clavien-Dindo classification ≥IIIa: 37.5% in SR group vs. 62.5% in HAR group; P = 0.080), except for postoperative liver abscess formation (P = 0.020). Five-year overall survival rates were 30.3% and 20.4%, respectively. No significant difference in overall survival rate was apparent between the SR and HAR groups (P = 0.150)., Conclusion: Despite being a demanding procedure, concomitant HAR appears feasible for selected patients with perihilar cholangiocarcinoma., (© 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

Major hepatic resection for hilar cholangiocarcinoma is reportedly closely associated with severe postoperative complications. We performed a new limited resection that included total resection of the caudate lobe and anterior segment (ventral region of the right paramedian sector), and bile duct resection with hepaticojejunostomy in 3 patients with hilar cholangiocarcinoma that had not infiltrated the hepatic artery or portal vein. In all 3 patients, curative surgical resections were obtained and no serious complications were encountered. This new limited resection based on a reclassification of the liver may offer an effective procedure in limited patients with hilar cholangiocarcinoma.

Although many reports have described laparoscopic minor liver resections, major hepatic resection, including right or left lobectomy, has not been widely developed because of technical difficulties. This article describes a new technique for performing laparoscopy-assisted right or left hepatic lobectomy using hilar Glissonean pedicle transection. Laparoscopic mobilization of the right or left hepatic lobe is performed, including dissection of the round, faliciform, triangular, and coronary ligaments. The right or left Glissonean pedicle is encircled and divided laparoscopically. A parenchymal dissection is then performed though the upper median or right subcostal incision, through which the resected liver is removed. We successfully performed this procedure in 6 patients without blood transfusion or serious complications. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection can be feasible and safe in highly selected patients.

Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

Ninety-five patients with liver cancer and cirrhosis who had undergone hepatic lobectomy or partial hepatectomy were studied. According to nutritional protocol based on experimental results, a large quantity of fresh frozen plasma (FFP), and BCAA-enriched amino acids at 30 kcal/kg/d as an energy source were administered postoperatively for 7-10 days with strict restriction of sodium and total fluid volume. An elemental diet for liver dysfunction (ED-H) was given to 13 patients at more than 1,500 kcal/d via a naso-duodenal feeding tube for 7-14 days. Six patients were given 15 g/d of BCAA granules after discharge for as long as possible. Serum levels of TP, Alb, T.Bil and PT were kept moderately high in the IVH and ED-H group. Although BCAA/AAA molar ratio was kept high when IVH or ED-H was provided, it gradually fell if nutritional management was discontinued. This ratio was maintained within normal limits by oral administration of BCAA granules. According to the Child classification, 1,2,3 and 5-year cumulative survival rates were 80.9, 62.9, 44.1 and 25.5% for Child A, 70.0, 43.1, 43.1 and 0% for Child B, and 50.0, 25.0, 0 and 0% for Child C, respectively. These data indicate the importance of nutritional support for improvement of nutritional status and for obtaining a better prognosis. Oral BCAA supplementation should be useful for the performance of long-term nutritional management for cancer patients with liver cirrhosis.

B Background: b Back ground: Concomitant major vascular resection was required to achieve curative (R0) resection in perihilar cholangiocarcinoma, however, it is also difficult to go together R0 resection and surgical safety. There were 78 of portal vein resection, 4 of hepatic artery resection, and 22 of both portal vein and hepatic artery. [Extracted from the article]

B Background: b Purpose: To assess proper criteria for post-hepatectomy liver failure (PHLF) in surgery for perihilar cholangiocarcinoma (PHCC) as early predictors of PHLF-related mortality. B Methods: b Methods: Participants comprised 183 PHCC patients who had undergone major hepatectomy. B Conclusion: b Conclusions: The 3-3-50 and Max T-Bil criteria could prove useful for defining PHLF-related mortality after hepatectomy for PHCC. [Extracted from the article]