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Background: We studied the prognostic impact of sarcopenia after hepatic resection for intrahepatic cholangiocarcinoma (ICC)., Methods: Sixty-one patients who underwent surgery for ICC during 2000-2017 were analyzed retrospectively. Psoas muscle areas were measured on CT scans at the third lumbar vertebra. Areas less than the sex-specific median were deemed low skeletal muscle masses (SMMs)., Results: Low-SMM patients were significantly more often older (p = 0.002) than high-SMM patients, had lower serum albumin (p = 0.004), higher serum C-reactive protein (CRP) (p = 0.002), and higher carbohydrate antigen 19-9 (p < 0.001). Five-year overall survival rates were 72.5% and 17.6% and 5-year recurrence-free survival rates were 58.6% and 21.1%, respectively, in high- and low-SMM patients. Multivariable analysis revealed that low SMM predicted unfavorable prognoses. SMM was associated with immune nutritional status (e.g., prognostic nutritional index, Glasgow prognostic score, CRP/albumin ratio)., Conclusion: Low SMM was related to worse surgical outcomes in patients with ICC following hepatic resection., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The aims of this study were to clarify the relationship of gait speed, hand grip strength, and skeletal muscle mass with complications after hepatic resection and to identify risk factors for complications in patients who underwent hepatic resection., Methods: We evaluated the risk factors for complications after hepatic resection in 154 consecutive patients. Preoperative factors included gait speed, hand grip strength, and skeletal muscle mass. The gait speed and hand grip strength of patients were measured by physical therapists, and skeletal muscle mass was measured by computed tomography. Multivariate logistic regression analyses using preoperative factors were performed to assess predictors of the development of complications after hepatic resection., Results: Thirty-three patients (21.4%) developed complications after hepatic resection. These patients had a significantly lower serum albumin level (p = 0.015), slower gait speed (p = 0.007), higher rate of hepatic resection ≥ 2 Couinaud segments (p = 0.014), and lower rate of laparoscopic hepatic resection (p = 0.017) than patients without complications. Multivariate analysis revealed that a gait speed ≤ 1.10 m/s and a serum albumin level of ≤ 4.0 g/dl were independent risk factors for complications after hepatic resection., Conclusions: Slow gait speed and low serum albumin level are significant risk factors for complications after hepatic resection. These data will be helpful for perioperative patient management.

Objective: To clarify the prognostic value of the preoperative blood neutrophil-to-lymphocyte ratio (NLR) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC)., Background: Although a high NLR has been reported to be a predictor of poor survival in patients with various cancers, it has not been extensively examined in patients with HCC., Methods: This retrospective study enrolled 958 patients who underwent hepatectomy without preoperative therapy for HCC from 1996 to 2009. Clinicopathological parameters, including NLR, were evaluated to identify predictors of overall and recurrence-free survival after hepatectomy. Univariate and multivariate analyses were performed, using the Cox proportional hazards model. The best cutoff was determined with time-dependent receiver operating characteristic curve. To determine the mechanism of NLR elevation, immunohistological examination using CD163 staining was performed in 150 patients., Results: Univariate and multivariate analyses showed that NLR was an independent prognostic factor in overall and recurrence-free survival. The best cutoff of NLR was 2.81, and 238 of 958 patients (24.8%) had NLR of more than 2.81. The 5-year survival rate after hepatectomy was 72.9% in patients with NLR less than 2.81 and 51.5% in those with NLR 2.81 or more (P < 0.0001). CD163-positive cell counts were significantly higher in tumors in the group with NLR 2.81 or more than in the group with NLR less than 2.81 (P = 0.0004)., Conclusions: Our results show that NLR is an independent predictor of survival after hepatectomy in patients with HCC. Accumulation of tumor-associated macrophages in the tumor is associated with a high NLR.

Background: Pure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas., Methods: The medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011., Results: Seventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure., Conclusions: Pure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors.

Purpose: We analyzed the feasibility and safety of our preliminary surgical approach for total hepatic resection of the right hepatic vein drainage area (THR-RHV) with the aid of three-dimensional computed tomography (3D-CT) guidance., Methods: Clinical findings and 3D-CT volumetry results were investigated in five patients who underwent THR-RHV for a hepatic malignant tumor close to the right hepatic vein (RHV)., Results: The mean estimated remnant liver volume after a conventional right lobectomy was 474 ml, whereas that after THR-RHV was 614 ml, indicating that 140 ml (13.8%) of additional liver volume had been preserved by performing THR-RHV. The median operative time, mean ischemic time, and mean blood loss during surgery were 406 min, 51 min, and 587 ml, respectively. Histological examinations confirmed a negative surgical margin in all five patients. The mean liver volume estimated by 3D-CT was 458 ml, whereas the mean actual resected liver volume was 468 g, resulting in a mean error ratio of 3.1%., Conclusions: THR-RHV allowed for a higher remnant liver volume than that after conventional right lobectomy of the liver, and proved feasible with acceptable perioperative results. This technique thus promotes both safety and curability for patients with a tumor close to the RHV.

Background: The aim of this study was to elucidate the predictors of extrahepatic hepatocellular carcinoma (HCC) recurrence after hepatectomy., Materials and Methods: A cohort of 252 patients with HCC who underwent hepatectomy following a recurrence were reviewed. The patients were categorized into 2 groups according to the pattern of their initial recurrence. Clinicopathological and survival data were compared between the groups., Results: Of the 252 patients, 218 had intrahepatic recurrence (IHR) (86.5%) and 34 had extrahepatic recurrence (EHR) (13.5%) as their initial recurrence. The mean duration of time until the initial recurrence after hepatectomy of the EHR and IHR groups was 1.8 and 2.2 years, respectively. The rate of recurrence within 6 months after hepatectomy of EHR and IHR groups was 35.3 and 14.2%, respectively (P = .002). The 3-, 5-, and 10-year cumulative survival rates of EHR group were 60.3, 24.0, and 6.0%, respectively, which were significantly lower than that of IHR group (74.5, 57.7, and 23.1%, P = .004). A multivariate analysis showed that blood loss during surgery and microscopic hepatic vein invasion remained as independent risk factors for increased EHR after hepatectomy for HCC. Furthermore, the combination of these 2 independent factors showed a significant association with the EHR., Conclusions: EHR of HCC was associated with early recurrence and a poor survival after a hepatectomy. The combination of 2 independent factors for EHR, the presence of microscopic hepatic vein invasion and the blood loss during surgery, may be useful for predicting the risk for occurrence of EHR during the follow-up period.

Background: The present study was conducted to clarify the pathological factors in patients who underwent surgery for mass-forming type intrahepatic cholangiocarcinoma (IHC)., Methods: From 1982 to July 2004, a total of 60 liver resections for mass-forming type IHC were performed at Kyushu University and its affiliated institutions. Portal venous, lymphatic, hepatic venous, and serosal invasion was examined by univariate and multivariate analyses for their prognostic value. The portal venous (PV) invasion index was defined as follows: PV0, portal venous invasion (-) and intrahepatic metastasis (-); PV1, portal venous invasion (+) or intrahepatic metastasis (+); PV2, portal venous invasion (+) and intrahepatic metastasis (+). The lymphatic invasion (LI) index was defined as follows: LI0, lymphatic duct invasion (-) and lymph node metastasis (-); LI1, intrahepatic lymphatic duct invasion (+) or lymph node metastasis (+); LI2, intrahepatic lymphatic duct invasion (+) and lymph node metastasis (+)., Results: In univariate analysis, statistically significant prognostic factors for poor outcome were tumor size (>5 cm), serosal invasion (+), PV1 or PV2, LI1 or LI2, histological grade (moderate and poor), hepatic venous invasion (+) and noncurative resection. After multivariate analysis, the lymphatic invasion index and histological grade were statistically independent prognostic factors for overall survival and recurrence-free survival., Conclusions: In patients with mass-forming type IHC, lymphatic invasion is the most important invasion pathway, compared with serosal and portal and hepatic venous invasion. Stratification of the lymphatic invasion pathway by lymphatic invasion, including intrahepatic lymphatic duct invasion and lymph node metastasis, is a good predictor for prognosis in patients after hepatectomy for mass-forming type IHC.

Purpose: Selected patients with initially unresectable colorectal cancer (CRC) and liver metastases undergo conversion surgery after appropriate chemotherapy. The prognosis of these patients is good, with some even cured of the disease. This retrospective, single-institution study analyzes the clinical importance of patient characteristics on the outcomes of conversion hepatectomy. Methods: We evaluated 229 consecutive patients with initially unresectable CRC and liver metastasis, who underwent systemic chemotherapy. The patients were assigned to groups depending on conversion hepatectomy. Results: Conversion hepatectomy was performed in 30 patients (13.1%). The proportion of patients with extrahepatic metastasis was significantly lower in the conversion group than in the unresectable group (30.0 vs. 66.8%; P < 0.01). The rate of left-sided primary colorectal tumors was significantly higher in the conversion group than in the unresectable group (96.7 vs. 65.8%; P < 0.01). Multivariate analyses identified that left-sided tumors, no extrahepatic metastasis, H1 or H2 grade CLM, and treatment with molecular-targeted agents were associated with conversion hepatectomy (odds ratios: 16.314, 4.216, 7.631, and 4.070; P < 0.01). Overall survival was significantly longer in the conversion group than in the unresectable group (MST: 50.0 versus 14.7 months; P < 0.01). Conclusion: Left-sided primary tumors, absence of extrahepatic metastases, H1 or H2 grade, and use of molecular-targeted agents were associated with successful conversion hepatectomy; thus, patients with these characteristics may be candidates for conversion therapy. [ABSTRACT FROM AUTHOR]

Then, the right lobe of the liver was partially dissected from the retroperitoneum, and the IRHV was safely tape-controlled by the caudal side of the liver following the division of the suprarenal vein (Fig. Finally, the short hepatic veins were divided, the right lobe of the liver was dissected from the diaphragm and right adrenal grand, and then the specimen was removed from the operative field (Fig. [Extracted from the article]

Purpose. Genetic polymorphisms of MICA and DEPDC5 have been reported to correlate with progression to hepatocellular carcinoma (HCC) in chronic hepatitis C patients. However, correlation of these genetic variants with HCC recurrence following hepatectomy has not yet been clarified. Methods. Ninety-six consecutive HCC patients who underwent hepatectomy, including 64 patients who were hepatitis C virus (HCV) positive, were genotyped for MICA (rs2596542) and DEPDC5 (rs1012068). Recurrence-free survival rates (RFS) were compared for each genotype. Results. Five-year HCC recurrence-free survival (RFS) rates following hepatectomy were 20.7% in MICA GG allele carriers, 38.7% in GA, and 20.8% in AA, respectively (P = 0 72). The five-year RFS rate was 23.8% in DEPDC5 TT allele carriers and 31.8% in TG/GG, respectively (P = 0 47). The survival rates in all (including HCV-negative) patients were also similar among each MICA and DEPDC5 genotype following hepatectomy. Among HCV-positive patients carrying the DEPDC5 TG/GG allele, low fibrosis stage (F0-2) occurred more often compared with TT carriers (P < 0 05). Conclusions. Neither MICA nor DEPDC5 genetic polymorphism correlates with HCC recurrence following hepatectomy. DEPDC5 minor genotype data suggest a high susceptibility for HCC development in livers, even those with low fibrosis stages. [ABSTRACT FROM AUTHOR]