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Objective To investigate the technique and dosage selection of indocyanine green(ICG) fluorescence staining in laparoscopic anatomical hemihepatectomy. Methods A retrospective cross-sectional study was conducted. The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed, and the management of the Glissonean pedicle, the method and effect of ICG fluorescence staining during the operation, the dose of ICG injection, and the postoperative recovery were analyzed. Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study, including 28 right hemihepatectomies and 63 left hemihepatectomies. The Glissonean pedicle was dissected intra-sheath in 9 cases and extra-sheath in 82 cases. ICG fluorescence staining was all performed using the negative staining method, of which 69 cases(75.8%) were successfully stained. The success rate of staining in the extra-sheath dissection and low-dose ICG group was higher than that in the intra-sheath dissection and high-dose ICG group. The average operation time was (168.5±32.2) minutes, the intraoperative bleeding volume was (152.4±56.3) ml, and the intraoperative blood transfusion rate was 6.6% (6/91), the average postoperative hospital stay was (8.5±2.6) days. One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle. Four cases had Clavien-Dindo Ⅰ-Ⅱ complications, all of which improved after treatment. There were 3 cases of grade Ⅲa complications, all of which were caused by bile leakage and abdominal cavity infection. They were cured by puncture and drainage. And there were no serious complications above grade Ⅲb. Conclusions In laparoscopic anatomical hemihepatectomy, the ICG fluorescence staining method was recommended to use the negative staining method of the extra-sheath dissection of the Glissonean pedicle, and a lower dose of ICG could help to increase the success rate of fluorescence staining.

The IMM (Institut Mutualiste Montsouris) difficulty classification for laparoscopic liver resection is based only on the type of surgical procedure. It is useful for assessing outcomes and setting benchmarks in a group sharing the same indications. There is, however, no left medial sectionectomy in the system. Its difficulty was evaluated using the same methodology as IMM with the data from a personal series. Furthermore, length of hospital stay was evaluated as the representative of short-term outcomes. IMM scores of our right and left hemihepatectomies, right anterior sectionectomy, and segment 7 or 8 segmentectomies are 3. That of left medial sectionectomies is 2, the same as right posterior sectionectomy and segment or less anatomical resections. Those of left lateral sectionectomy and partial resection are 0. The group with a score of 3 was divided into two groups—with and without extended hospital stays (extended only for right hemihepatectomies and right anterior sectionectomies). The difficulty of medial sectionectomy was positioned at the same level as posterior sectionectomy and segment or less anatomical resections. The result from the second evaluation may indicate that there are other factors with an impact on difficulty related to short-term outcomes, other than intraoperative surgical difficulty from the procedure itself. [ABSTRACT FROM AUTHOR]

Laparoscopic removal of the affected part of the organ and classic laparotomic resection with open access for surgical manipulations are widespread. The choice of resection method is still controversial because researchers are currently talking about the importance of minimally invasive surgical techniques. The purpose of this study was primarily to compare the intraoperative, early, and late postoperative status of patients who underwent laparoscopic or laparotomic hepatic resection for multiple foci of hepatocellular carcinoma. In general, the operations using the laparoscopy method are much safer, because perioperative complications (including intense stress reactions with the appearance of hypertension, suppression of the immune response, tachycardia, and hypercoagulability) occur much less frequently than in the case of open-access intervention. Less invasiveness of laparoscopic operations contributes to a better recovery of patients after resection. On the other hand, laparotomy provides wider and faster access to the liver. This meta-analysis compares the effectiveness of minimally invasive laparoscopic resections over classic laparotomic operations in patients diagnosed with hepatocellular carcinoma with multiple tumors.

Abstract Background The main surgical procedure for Bismuth‒Corlette III–IV hilar cholangiocarcinoma (HCCA) is hemihepatectomy/extended hemihepatectomy. However, many patients have no opportunity for surgery due to having an insufficient remnant liver volume. Preservation of more liver volume on the premise of ensuring R0 resection is the goal. Mesohepatectomy with caudate lobectomy may be a new method to meet these requirements. Methods The clinical data of 41 patients with Bismuth‒Corlette III–IV HCCA, including 18 patients who underwent mesohepatectomy with caudate lobectomy (the mesohepatectomy group) and 23 patients who underwent hemihepatectomy or extended hemihepatectomy (the hemihepatectomy group), were analyzed retrospectively. The perioperative indicators and prognostic survival time between the two groups were analyzed. Results The mesohepatectomy group was compared with the hemihepatectomy group, and the operation time was 7.95 ± 1.2 vs. 7.15 ± 1.5 h (P > 0.05); the intraoperative blood loss was 600.0 ± 153.4 vs. 846.1 ± 366.8 mL (P 0.05). The postoperative complications of the two groups included bile leakage (22.2% vs. 21.7%), pleural effusion (11.1% vs. 8.7%), and fever (16.7% vs. 8.7%), with no significant differences in the incidences (P > 0.05). The 1-, 3-, and 5-year survival rates of the two groups were 87.5%, 55.7%, 27.8% and 83.5%, 56.1%, 24.5%, respectively, with no significant differences (P > 0.05). Conclusions Mesohepatectomy with caudate lobectomy can preserve more functional liver volume while ensuring the bile duct margin. It can be applied as the surgical treatment of Bismuth‒Corlette III–IV HCCA.

Abstract Background Hepatitis B core antibody (HBcAb) positivity is considered a prior hepatitis B virus (HBV) infection. However, little is known about the effect of HBcAb positivity on surgical safety for hilar cholangiocarcinoma (hCCA). The present study aims to investigate the role of HBcAb positivity on postoperative complications of hCCA. Methods A retrospective analysis was performed on the status of HBcAb positivity, liver fibrosis, perioperative surgical complications, and long‐term outcomes of hCCA patients with Hepatitis B surface antigen (HBsAg) negativity who underwent surgical treatment in Tongji Hospital from April 2012 to September 2019. Results HBcAb positivity with negative HBsAg occurs in 137 hCCA patients (63.1%). A total of 99 hCCA patients with negative HBsAg underwent extended hemihepatectomy, of whom 69 (69.7%) and 30 (30.3%) were HBcAb‐positive and HBcAb‐negative, respectively. Significant fibrosis was detected in 63.8% of the patients with HBcAb‐positive, which was markedly higher than those with HBcAb‐negative (36.7%) (p = 0.016). The postoperative complications and 90‐day mortality rates were 37.4% (37/99) and 8.1% (8/99), respectively. The incidence of postoperative complications in HBcAb‐positive patients (44.9%) was significantly higher than that in HBcAb‐negative patients (20.0%) (p = 0.018). All the patients who died within 30‐day after surgery were HBcAb‐positive. Multivariate analysis showed that the independent risk factors for complications were HBcAb positivity, preoperative cholangitis, portal occlusion >15 min, and significant fibrosis. There were no significant differences in recurrence‐free survival (RFS) and overall survival (OS) between HBcAb‐positive and HBcAb‐negative patients (p = 0.642 and p = 0.400, respectively). Conclusions HBcAb positivity is a common phenomenon in hCCA patients from China, a country with highly prevalent HBcAb positivity. The status of HBcAb‐positive markedly increases the incidence of postoperative complications after extended hemihepatectomy for hCCA patients.

Background: The main surgical procedure for Bismuth‒Corlette III–IV hilar cholangiocarcinoma (HCCA) is hemihepatectomy/extended hemihepatectomy. However, many patients have no opportunity for surgery due to having an insufficient remnant liver volume. Preservation of more liver volume on the premise of ensuring R0 resection is the goal. Mesohepatectomy with caudate lobectomy may be a new method to meet these requirements. Methods: The clinical data of 41 patients with Bismuth‒Corlette III–IV HCCA, including 18 patients who underwent mesohepatectomy with caudate lobectomy (the mesohepatectomy group) and 23 patients who underwent hemihepatectomy or extended hemihepatectomy (the hemihepatectomy group), were analyzed retrospectively. The perioperative indicators and prognostic survival time between the two groups were analyzed. Results: The mesohepatectomy group was compared with the hemihepatectomy group, and the operation time was 7.95 ± 1.2 vs. 7.15 ± 1.5 h (P > 0.05); the intraoperative blood loss was 600.0 ± 153.4 vs. 846.1 ± 366.8 mL (P < 0.05); the postoperative hospital stay was 9.9 ± 2.2 vs. 13.8 ± 3.0 days (P < 0.05); and the R0 resection rate was 100% vs. 87.0% (P > 0.05). The postoperative complications of the two groups included bile leakage (22.2% vs. 21.7%), pleural effusion (11.1% vs. 8.7%), and fever (16.7% vs. 8.7%), with no significant differences in the incidences (P > 0.05). The 1-, 3-, and 5-year survival rates of the two groups were 87.5%, 55.7%, 27.8% and 83.5%, 56.1%, 24.5%, respectively, with no significant differences (P > 0.05). Conclusions: Mesohepatectomy with caudate lobectomy can preserve more functional liver volume while ensuring the bile duct margin. It can be applied as the surgical treatment of Bismuth‒Corlette III–IV HCCA. [ABSTRACT FROM AUTHOR]

Abstract Introduction Clinicians increasingly perform laparoscopic surgery for intrahepatic cholangiocarcinoma (ICC). However, this surgery can be difficult in patients with advanced-stage ICC because of the complicated procedures and difficulty in achieving high-quality results. We compared the effects of a three-step optimized procedure with a traditional procedure for patients with advanced-stage ICC. Methods Forty-two patients with advanced-stage ICC who received optimized laparoscopic hemihepatectomy with lymph node dissection (LND, optimized group) and 84 propensity score-matched patients who received traditional laparoscopic hemihepatectomy plus LND (traditional group) were analyzed. Surgical quality, disease-free survival (DFS), and overall survival (OS) were compared. Results The optimized group had a lower surgical bleeding score (P = 0.038) and a higher surgeon satisfaction score (P = 0.001). Blood loss during hepatectomy was less in the optimized group (190 vs. 295 mL, P

Background: Hepatitis B core antibody (HBcAb) positivity is considered a prior hepatitis B virus (HBV) infection. However, little is known about the effect of HBcAb positivity on surgical safety for hilar cholangiocarcinoma (hCCA). The present study aims to investigate the role of HBcAb positivity on postoperative complications of hCCA. Methods: A retrospective analysis was performed on the status of HBcAb positivity, liver fibrosis, perioperative surgical complications, and long‐term outcomes of hCCA patients with Hepatitis B surface antigen (HBsAg) negativity who underwent surgical treatment in Tongji Hospital from April 2012 to September 2019. Results: HBcAb positivity with negative HBsAg occurs in 137 hCCA patients (63.1%). A total of 99 hCCA patients with negative HBsAg underwent extended hemihepatectomy, of whom 69 (69.7%) and 30 (30.3%) were HBcAb‐positive and HBcAb‐negative, respectively. Significant fibrosis was detected in 63.8% of the patients with HBcAb‐positive, which was markedly higher than those with HBcAb‐negative (36.7%) (p = 0.016). The postoperative complications and 90‐day mortality rates were 37.4% (37/99) and 8.1% (8/99), respectively. The incidence of postoperative complications in HBcAb‐positive patients (44.9%) was significantly higher than that in HBcAb‐negative patients (20.0%) (p = 0.018). All the patients who died within 30‐day after surgery were HBcAb‐positive. Multivariate analysis showed that the independent risk factors for complications were HBcAb positivity, preoperative cholangitis, portal occlusion >15 min, and significant fibrosis. There were no significant differences in recurrence‐free survival (RFS) and overall survival (OS) between HBcAb‐positive and HBcAb‐negative patients (p = 0.642 and p = 0.400, respectively). Conclusions: HBcAb positivity is a common phenomenon in hCCA patients from China, a country with highly prevalent HBcAb positivity. The status of HBcAb‐positive markedly increases the incidence of postoperative complications after extended hemihepatectomy for hCCA patients. The present study aims to evaluate the prevalence of HBcAb positivity in hCCA patients and explore the effect of HBcAb positivity on postoperative complications of hCCA patients after curative resection. Among all the 217 patients, 160 (73.7%) patients were HBcAb positive. Data of 99 HBsAg negative patients who underwent curative resection were analyzed, and the HBcAb positivity markedly increased the risk of postoperative complications and mortality after curative resection for hCCA. Surgeons should pay more attention to HBcAb status in hCCA patients with negative HBsAg, which could help them to select optimal surgical modalities. [ABSTRACT FROM AUTHOR]

ObjectivePost-hepatectomy liver failure (PHLF) remains clinical challenges after major hepatectomy. The aim of this study was to establish and validate a deep learning model to predict PHLF after hemihepatectomy using preoperative contrast-enhancedcomputed tomography with three phases (Non-contrast, arterial phase and venous phase).Methods265 patients undergoing hemihepatectomy in Sir Run Run Shaw Hospital were enrolled in this study. The primary endpoint was PHLF, according to the International Study Group of Liver Surgery’s definition. In this study, to evaluate the proposed method, 5-fold cross-validation technique was used. The dataset was split into 5 folds of equal size, and each fold was used as a test set once, while the other folds were temporarily combined to form a training set. Performance metrics on the test set were then calculated and stored. At the end of the 5-fold cross-validation run, the accuracy, precision, sensitivity and specificity for predicting PHLF with the deep learning model and the area under receiver operating characteristic curve (AUC) were calculated.ResultsOf the 265 patients, 170 patients with left liver resection and 95 patients with right liver resection. The diagnosis had 6 types: hepatocellular carcinoma, intrahepatic cholangiocarcinoma, liver metastases, benign tumor, hepatolithiasis, and other liver diseases. Laparoscopic liver resection was performed in 187 patients. The accuracy of prediction was 84.15%. The AUC was 0.7927. In 170 left hemihepatectomy cases, the accuracy was 89.41% (152/170), and the AUC was 82.72%. The accuracy was 77.47% (141/182) with liver mass, 78.33% (47/60) with liver cirrhosis and 80.46% (70/87) with viral hepatitis.ConclusionThe deep learning model showed excellent performance in prediction of PHLF and could be useful for identifying high-risk patients to modify the treatment planning.

Purpose: The middle hepatic vein (MHV) is an important landmark in anatomical hemihepatectomy. The proximity between the MHV and the hilar plate was suspected to be associated with tumor exposure during left hemihepatectomy for advanced perihilar cholangiocarcinoma and is reported to facilitate a dorsal approach to the MHV during laparoscopic hemihepatectomy. However, the precise distance between these locations is unknown. Methods: To investigate the "accurate and normal" distance between the MHV and the hilar plate, the present study focused on patients who presented without perihilar tumor. One hundred and sixty-eight consecutive patients who underwent pancreatoduodenectomy were included. Retrospective radiological measurement was performed using preoperative multi-detector row CT. The optimized CT slices perpendicular to the MHV were made using the multiplanar reconstruction technique. The shortest distance between the MHV and the hilar plate was measured on the left and right sides on the perpendicular slices. The diameters of the left and right hepatic ducts were also measured. Results: The distance was 9.0 mm (1.9–20.0 mm) on the left side and 11.3 mm (2.3–21.8) on the right side (p < 0.001). The distance on the left side was < 10 mm in 60% of patients (n = 100). Only one-third of patients (n = 55) had a distance of ≥ 10 mm on both sides. As the hepatic ducts became more dilated, the distance from the MHV to the hilar plate became shorter. Conclusion: The MHV was located in close proximity to the hepatic hilus, especially on the left side. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing hemihepatectomy. Methods: From January 2017 to June 2019, 54 and 56 patients were enrolled into the control and ERAS group, retrospectively. All the indicators related to operation, liver functions, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) analysis identified 72 patients for further analysis. Results: The clinicopathological characteristics were well-matched after PSM, and there were no significant differences in the operative duration, blood loss, blood transfusion, hospital costs, and most postoperative indicators in these 2 groups. In the ERAS group, D-dimer and fibrin degradation product values were significantly reduced (3.57 (2.874.60) μg/ml vs 4.81 (3.948.29) μg/ml and 11.90 (10.0418.02) μg/ml vs 15.80 (11.5529.24) μg/ml; P =.002 and P =.023, respectively). The days that semiliquid diet was allowed after surgery (2.00 (2.003.00) days vs 5.00 (4.006.00) days, P <.001), abdominal drainage tube indwelling duration (5.00 (4.005.00) days vs 5.00 (4.756.25) days, P =.004), and hospital stay after surgery (6.00 (6.007.00) days vs 8.00 (7.0010.00) days, P <.001) were also significantly shorter. The proportion of patients requiring analgesic treatment was significantly lower in the postoperative day 2 and day 4 (P <.001 and P =.025, respectively). The morbidity was significantly less (36.11% vs 69.44%, P =.005). Conclusions: ERAS programs are feasible and safe in HCC patients undergoing hemihepatectomy. Postoperative anticoagulant therapy may be one of the necessary steps. [ABSTRACT FROM AUTHOR]

We aimed to describe our procedure for vascular reconstruction and back table bench preparation for the right lobe live donor allograft. Live donor liver transplantation (LDLT) remains an important option for the expansion of the donor pool. The procedure has been widely used, and its success is dependent on a technically perfect operation with appropriate inflow and outflow of the allograft. Adequate preparation of the right lobe (RL) allograft prior to implantation remains a vital part of the procedure. Our technique of back table vascular reconstruction of the RL allograft has been performed using a hepatic vein patch venoplasty, inferior hepatic vein inclusion, portal vein reconstruction, and segment V and VIII reconstruction for all of our LDLTs. Between March 2009 and January 2020, 321 consecutive adult LDLTs were performed and underwent back table reconstruction with the techniques described. During that time period, no patients had hepatic insufficiency. There was a single thrombosis of a superior mesenteric vein (SMV) to PV jump conduit. Our technique of back table reconstruction of the LDLT right lobe graft remains a crucial part of the operative procedure. Our experience with RL grafts without middle hepatic vein (MHV) and our systematic approach for inflow and outflow reconstruction has yielded excellent results with no technical outflow issues and minimal inflow complications. [ABSTRACT FROM AUTHOR]

Abstract Background Laennec’s capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported. Methods We retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec’s approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed. Results Four of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec’s approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec’s capsule does exist around the peripheral hepatic veins with histological confirmation. Conclusions Laennec’s approach is safe and feasible for LAH. Precise isolation of Laennec’s approach based on Laennec’s capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.

Currently the main way of curable treatment of hepatocellular carcinomas (HCC)* is a liver resection. Candidates for surgery are patient with good score of liver function (Child-Pugh A group), without destruction of great vessels and distant metastases. Hemihepatectomy is associated with a high risk of postoperative liver failure (including portal hypertension, cirrhosis, portal vein thrombosis). This reason leads to premature failure of the operation. According to current clinical guidelines, system therapy is more suitable, despite of the lack of reliable data on its effectiveness in such clinical situations. The presented cases may support the selection of advanced hemihepatectomy as a treatment for hepatocellular cancer C stage BCLC classification.

Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas. Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria. Results There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P 0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P

Introduction. Hilar cholangiocarcinoma (HC) is a tumor that requires a multidisciplinary approach and treatment. The 3- and 5-year survival rates of HC patients treated with surgery and palliative methods were evaluated in the study. Material and methods. The study covered 368 patients treated between 2000-2014. Of them, 137 patients were categorized for surgery (RT group), and 231 for palliative treatment (PT group). The overall 3- and 5-year survival rates were determined by the log-rank test. The Cox hazard regression model revealed the relative prognostic factors. Results. The 3- and 5-year survival rates accounted for 38% and 21% after surgery, but 13% and 0 after palliative treatment (p < 0.0001). Radical tumor resection, negative lymph nodes, and early tumor T stage were the factors conducive to survival. Conclusions. Surgery, if the radical tumor resection is possible, offers a chance for long-term survival. The effects of surgical treatment are of little consequence in the face of poor treatment outcomes of palliative patients, however. [ABSTRACT FROM AUTHOR]

Background: Laennec's capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec's approach are rarely reported. Methods: We retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec's approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed. Results: Four of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec's approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec's capsule does exist around the peripheral hepatic veins with histological confirmation. Conclusions: Laennec's approach is safe and feasible for LAH. Precise isolation of Laennec's approach based on Laennec's capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy. [ABSTRACT FROM AUTHOR]

Abstract Background One of the major causes of perioperative mortality of patients undergoing major hepatic resections is post-hepatectomy liver failure (PHLF). For preoperative appraisal of the risk of PHLF it is important to accurately predict resectate volume and future liver remnant volume (FLRV). The objective of our study is to prospectively evaluate the accuracy of hemihepatectomy resectate volumes that are determined by computed tomography volumetry (CTV) when compared with intraoperatively measured volumes and weights as gold standard in patients undergoing hemihepatectomy. Methods Twenty four patients (13 women, 11 men) scheduled for hemihepatectomy due to histologically proven primary or secondary hepatic malignancies were included in our study. CTV was performed using a semi-automated module (S, hereinafter) (syngo.CT Liver Analysis VA30, Siemens Healthcare, Germany). Conversion factors between CT volumes on the one side and intraoperative volumes and weights on the other side were calculated using the method of least squares. Absolute and relative disagreements between CT volumes and intraoperative volumes were determined. Results A conversion factor of c = 0.906 most precisely predicted intraoperative volumes of exsanguinated hemihepatectomy specimens from CT volumes in all patients with mean absolute and relative disagreements between CT volumes and intraoperative volumes of 57 ml and 6.3%. The use of operation-specific conversion factors yielded even better results. Conclusions CTV performed with S accurately predicts intraoperative volumes of hemihepatectomy specimens when applying conversion factors which compensate for exsanguination. This allows to precisely estimate the FLRV and thus minimize the risk of PHLF in patients undergoing major hepatic resections.

Background: Minimally invasive approach has been increasingly applied in liver resection. However, laparoscopic major hepatectomy is technically demanding and is practiced only in expert centers around the world. Conversely, use of robot may help to overcome the difficulty and facilitate major hepatectomy.Methods: Between September 2010 and March 2019, 151 patients received robotic hepatectomy for various indications in our center. 36 patients received robotic hemihepatectomy: 26 left hepatectomy and 10 right hepatectomy. During the same period, 737 patients received open hepatectomy and out of these, 173 patients received open hemihepatectomy. A propensity score-matched analysis was performed in a 1:1 ratio.Results: After matching, there were 36 patients each in the robotic and open group. The two groups were comparable in demographic data, type of hemihepatectomy, underlying pathology, size of tumor, and background cirrhosis. Conversion was needed in 3 patients (8.3%) in the robotic group. There was no operative mortality. The operative blood loss and resection margin were similar. Though not significantly different, there was a higher rate of complications in the robotic group (36.1% vs. 22.2%) and this difference was mostly driven by higher intra-abdominal collection (16.7% vs. 5.6%) and bile leak (5.6% vs. 2.8%). Operative time was significantly longer (400.8 ± 136.1 min vs 255.4 ± 74.4 min, P < 0.001) but the postoperative hospital stay was significantly shorter (median 5 days vs 6.5 days, P = 0.040) in the robotic group. When right and left hepatectomy were analyzed separately, the advantage of shorter hospital stay remained in left but not right hepatectomy. For patients with hepatocellular carcinoma, there was no difference between the two groups in 5-year overall and disease-free survival.Conclusion: Compared with the open approach, robotic hemihepatectomy has longer operation time but shorter hospital stay. Thus, use of robot is feasible and effective in hemihepatectomy with the benefit of shorter hospital stay. [ABSTRACT FROM AUTHOR]

We report a case of successful robot-assisted major liver resection in a patient with liver alveolar echinococcosis (AE). A 62-year-old male patient was incidentally diagnosed with a large infiltrative lesion in the right liver lobe suspicious for AE. A radical surgical resection as a right-sided hemihepatectomy was indicated. The operation was carried out via a robotic-assisted procedure using the DaVinci Xi Surgical System. The tumor measured 12.4 × 8.8 cm and was successfully resected through a suprapubic incision of 13 cm. The patient was free of pain after the second post-operative day. A fluid collection near the resection plate was easily drained without bile leakage. The patient had no surgical complications. Radical resection is inevitable for adequate curative therapy of AE and provides clear margins. Robotic surgery is a relatively new and safe option for curative resection of AE lesions, with remarkable advantages for patients and surgeons.

Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.

The objective of the study was to determine the possibilities of surgical treatment and to evaluate the criteria for selecting the resection volume of the liver in patients with Klatskin tumor.Material and methods. From 2005 to 2018, 36 patients with Klatskin tumor aged from 30 to 74 years were operated in the Department of surgery of «Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov». Radical surgical interventions (R0) were performed in 28 (77.7 %) patients. 7 (19.5 %) patients underwent palliative surgery.Results. Selection of the resection volume of the liver and bile duct was carried out on the basis of assessment of the functional state, morphological changes in the liver and results of urgent intraoperative histological examination. As a radical intervention for IIIa, IIIb and IV types of Klatskin tumor (93.1 % of patients), extensive liver resection (left-sided or right-sided hemihepatectomy) with biliary and, in the presence of invasion into the main vessels, with vascular reconstruction was performed.Сonclusion. Timely and adequate liver resection with biliary reconstruction is a radical surgical intervention for Klatskin tumors. Selection of the resection volume of the liver, especially for type IV tumors, is determined by the morphological changes and the reserve capacity of the liver. The status of the resection edge is crucial for the selection of subsequent treatment tactics. Combination of methods of regional chemoinfusion and intraductal photodynamic therapy is necessary after non-radical intervention.

To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 (1–5; mild-death). Significance was tested using Wilcoxon signed-rank and Mann–Whitney U test. Kaplan–Meier estimation and log-rank test assessed survival. Overall 21 CS-PHP in seven patients (4/7 males; 52 ± 10 years) with hemihepatectomy (grouphemihep) and 22 CS-PHP in seven patients (3/7 males; 63 ± 12 years) without prior surgery (groupnoresection) were included. No complications occurred during the CS-PHP procedures. Transient changes (CTCAE grade 1–2) of liver enzymes and blood cells followed all procedures. In comparison, grouphemihep presented slightly more AEs grade 3–4 (e.g. thrombocytopenia in 57% (12/21) vs. 41% (9/22; p = 0.37)) 5–7 days after CS-PHP. These AEs were self-limiting or responsive to treatment (insignificant difference of pre-interventional to 21–45 days post-interventional values (p > 0.05)). One patient in grouphemihep with high tumor burden died eight days following CS-PHP. No deaths occurred in groupnoresection. In comparison, overall survival after first diagnosis was insignificantly shorter in groupnoresection (44.7(32–56.1) months) than in grouphemihep (48.3(34.6–72.8) months; p = 0.48). The severity of adverse events following CS-PHP in patients after hemihepatectomy was comparable to a matched group without prior liver surgery. Thus, the performance of CS-PHP is not substantially compromised by a prior hemihepatectomy. [ABSTRACT FROM AUTHOR]

Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH. [ABSTRACT FROM AUTHOR]

Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P < 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 h of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P<0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P<0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time. [ABSTRACT FROM AUTHOR]

Background: The use of the laparoscopic approach in one-stage or second-step of two-stage right hemihepatectomy (RHH) after portal vein embolization (PVE) in patients with initially unresectable colorectal liver metastases (CRLMs) is technically demanding. Currently, there is limited published data regarding the technique and results required to better understand its safety and feasibility. This paper reports our experience, results, techniques and variety of tips and tricks (highlighted in the attached video), to facilitate this resection.Methods: A prospectively maintained database of laparoscopic liver surgery within our unit at a tertiary referral centre between August 2003 and March 2019 was reviewed. Patients with initially unresectable CRLMs who underwent laparoscopic RHH or extended RHH after PVE in the context of a one or two-stage procedure were included.Results: Between August 2003 and March 2019, 19 patients with initially unresectable CRLMs underwent laparoscopic RHH after PVE. Twelve patients (63.2%) had RHH in the context of a two-stage hepatectomy and 7 as a one-stage procedure. Median time interval between PVE and surgery was 42.5 days (IQR, 34.5-60.0 days). Mean operating time was 351.8 ± 80.5 minutes. Median blood loss was 850 mL (IQR, 475-1350 mL). Conversion to open surgery occurred in 2 of 19 cases (10.5%). Severe postoperative morbidity occurred in 2 patients. The mortality rate was 5.3%. Median postoperative hospital stay was 5 days (IQR, 4-7 days). Radical resection was obtained in eighteen patients (94.7%).Conclusion: Laparoscopic RHH after PVE in the context of a one- or two-stage resection in patients with initially unresectable CRLMs is a safe and feasible procedure with favourable oncological outcomes. [ABSTRACT FROM AUTHOR]

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Introduction: A stronger evidence level is needed to confirm the benefits and limits of laparoscopic hemihepatectomies. Methods: Laparoscopic and open hemihepatectomies from nine European referral centers were compared after propensity score matching (right and left hemihepatectomies separately, and benign and malignant diseases sub‐analyses). Results: Five hundred and forty‐five laparoscopic hemihepatectomies were compared with 545 open. Laparoscopy was associated with reduced blood loss (P < 0.001), postoperative stay (P < 0.001) and minor morbidity (P = 0.002), supported by a lower Comprehensive Complication Index (CCI) (P = 0.035). Laparoscopic right hemihepatectomies were associated with lower ascites (P = 0.016), bile leak (P = 0.001) and wound infections (P = 0.009). Laparoscopic left hemihepatectomies exhibited a lower incidence of bile leak and cardiovascular complications (P = 0.024; P = 0.041), lower minor and major morbidity (P = 0.003; P = 0.044) and reduced CCI (P = 0.002). Laparoscopic major hepatectomies (LMH) for benign disease were associated with lower blood loss (P = 0.001) and bile leaks (P = 0.037) and shorter total stay (P < 0.001). LMH for malignancy were associated with lower blood loss (P < 0.001) and minor morbidity (P = 0.027) supported by a lower CCI (P = 0.021) and shorter stay (P < 0.001). Conclusion: This multicenter study confirms some associated advantages of laparoscopic left and right hemihepatectomies in malignant and benign conditions highlighting the need for realistic expectations of the minimally invasive approach based on the resected hemiliver and the patients treated. [ABSTRACT FROM AUTHOR]

Introduction: Cost efficiency is important for hospitals in order to provide high-quality health care for all patients. As hemihepatectomies are increasingly being performed laparoscopically, the aims of this study were to evaluate the costs of laparoscopic hemihepatectomy and to compare them to conventional open techniques. Patients and methods: This is a retrospective analysis of clinical outcomes and financial calculations of all patients who underwent hemihepatectomy between January 2015 and December 2016 at the Department of Surgery, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlin, Germany, being allocated to the DRG (diagnosis-related group) H01A (complex operations of the liver and pancreas with complex intensive care treatment) or H01B (operations of the liver and pancreas without complex intensive care treatment). To overcome selection bias, a 1:1 propensity score matching (PSM) analysis was performed. Results: After PSM, a total of 64 patients were identified; 32 patients underwent laparoscopic hemihepatectomy (LH); and 32 patients received open hemihepatectomy (OH). After PSM, no significant differences were observed in clinical baseline characteristics. The duration of surgery was significantly longer for patients undergoing LH compared to OH (LH, 334 min, 186–655 min; OH, 274 min, 176–454 min; p = 0.005). Patients in the LH group had a significantly shortened median hospital stay of 5 d, when compared to OH (LH, 9.5 d, 3–35 d; OH, 14.5 d, 7–37d; p = 0.005). We observed a significant higher rate of postoperative complication in the OH group (p = 0.022). Cost analysis showed median overall costs of 17,369.85€ in the LH group and 16,103.64€ in the OH group (p = 0.390). Conclusion: Our data suggest that higher intraoperative costs of laparoscopic liver surgery, e.g., for surgical devices and due to longer operation times, are compensated by fewer postoperative complications and consecutive shorter length of stay when compared with OH. [ABSTRACT FROM AUTHOR]

Objective To systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma (HCC). MethodsPubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5.3 software was used for data analysis. The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio (OR) was used for the analysis of binary variables, weighted mean difference (WMD) was used for the analysis of continuous variables, and 95% confidence interval (CI) was calculated for these variables. Results A total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients (1054 in the mesohepatectomy group and 807 in the hemihepatectomy group). The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group (OR=0.37, 95%CI: 0.16-0.87, P=0.02), while there were no significant differences between the two groups in time of operation (WMD=15.17, 95%CI: -18.75 to 49.05, P=0.38), intraoperative blood loss (WMD=100.96, 95%CI: -15.29 to 217.21, P=0.09), mortality rate in the perioperative period (OR=0.55, 95%CI: 0.26-1.17, P=0.12), incidence rate of bile leakage after surgery (OR=1.32, 95%CI: 0.74-2.38, P=0.35), overall survival rate, and disease-free survival rate. Conclusion Mesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy. [ABSTRACT FROM AUTHOR]

A 54-year-old woman presented with an incidentally identified asymptomatic liver lesion with imaging characteristics suspicious for malignancy. She underwent a left hemihepatectomy for presumed cholangiocarcinoma. Histopathology revealed granulomas with microbiological investigations later revealing a diagnosis of isolated hepatic tuberculosis. There were no pulmonary or other disease sites identified. The patient has been medically managed for primary hepatic tuberculosis and remains well postoperatively. This case identifies a rare differential for a liver mass that needs to be considered in the clinicians' workup. [ABSTRACT FROM AUTHOR]

Background: Liver cancer resection, especially in patients with hemihepatectomy or extended hemihepatectomy, often leads to poor prognosis, such as liver insufficiency and even liver failure and death, because the standard residual liver volume (SRLV) cannot be fully compensated after surgery., Aim: To explore the risk factors of poor prognosis after hemihepatectomy for hepatocellular carcinoma and evaluate the application value of related prognostic approaches., Methods: The clinical data of 35 patients with primary liver cancer in Nantong Third People's Hospital from February 2016 to July 2020 were retrospectively analyzed. The receiver operating characteristic curve was created using medcac19.0.4 to compare the critical values of the SRLV in different stages of liver fibrosis after hemihepatectomy with those of liver dysfunction after hemihepatectomy. It was constructed by combining the Child-Pugh score to evaluate its application value in predicting liver function compensation., Results: The liver stiffness measure (LSM) value and SRLV were associated with liver dysfunction after hemihepatectomy. Logistic regression analysis showed that an LSM value ≥ 25 kPa [odds ratio (OR) = 6.254, P < 0.05] and SRLV ≤ 0.290 L/m 2 (OR = 5.686, P < 0.05) were independent risk factors for postoperative liver dysfunction. The accuracy of the new liver reserve evaluation model for predicting postoperative liver function was higher than that of the Child-Pugh score ( P < 0.05)., Conclusion: SRLV and LSM values can be used to evaluate the safety of hemihepatectomy. The new liver reserve evaluation model has good application potential in the evaluation of liver reserve function after hemihepatectomy., Competing Interests: Conflict-of-interest statement: We have no financial relationships to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Adult hepatoblastoma (AHB) is a rare liver tumor with a poor prognosis in adolescents and adults. This contrasts with hepatoblastoma in children and is not fully understood. Here we describe two adolescents with AHB who were treated in our hospital. Adolescents are likely to receive less intensive chemotherapy protocols and are treated in hospitals with less experience in pediatric oncology, resulting in poor outcome. More research is necessary for optimal treatment of AHB in adolescents. Adolescents with AHB should be referred to hospitals experienced in pediatric oncology and receive intensive chemotherapy, followed by hemihepatectomy. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic hepatectomy has been performed in many hospitals, with the development of the laparoscopic operation technique. However, performing complex laparoscopic hepatectomy, such as right hemihepatectomy, is still a challenge. The aim of this study was to describe the application of a simple vascular occlusion technique and new liver hanging maneuver (LHM) in complex laparoscopic hepatectomy, which are both advocated by Chen Xiaoping for open hepatectomy.Methods: The clinical data of 29 consecutive patients who underwent laparoscopic right hemihepatectomy (LRH) from October 2014 to October 2016 were retrospectively analyzed. During operation, the vascular occlusion technique without hilus dissection and LHM through the retrohepatic avascular tunnel on the right side of the inferior vena cava were used.Result: All 29 operations were successfully performed laparoscopically, while adopting Chen's methods. The study consisted of 23 patients with hepatocellular carcinoma, four patients with intrahepatic cholangiocarcinoma, and two patients with hepatic metastasis of colonic carcinoma. The tumor size was 12.4 ± 1.9 cm. The operation time of LRH was 190.3 ± 49.9 min. The intraoperative blood loss of LRH was 281.7 ± 117.8 mL; five patients required blood transfusion, and the amount of blood transfusion was 300.0 ± 89.4 mL. No case was converted to open surgery, and no death occurred. All resulted in R0 resections. The median free margin was 20.1 ± 10.8 mm. The time of postoperative oral diet intake was 2.10 ± 0.96 days. The complication rate was 17.2%. The average hospital stay after operation was 10.0 ± 2.9 days.Conclusion: Complex hepatectomy is a bloodless procedure that can be performed under a laparoscope safely using Chen's methods of vascular occlusion technique and LHM. [ABSTRACT FROM AUTHOR]

Purpose: Three-dimensional (3D) printing for preoperative planning has been intensively developed in the recent years. However, the implementation of these solutions in hospitals is still difficult due to high costs, extremely expensive industrial-grade printers, and software that is difficult to obtain and learn along with a lack of a defined process. This paper presents a cost-effective technique of preparing 3D-printed liver models that preserves the shape and all of the structures, including the vessels and the tumor, which in the present case is colorectal liver metastasis. Methods: The patient's computed tomography scans were used for the separation and visualization of virtual 3D anatomical structures. Those elements were transformed into stereolithographic files and subsequently printed on a desktop 3D printer. The multipart structure was assembled and filled with silicone. The patient underwent subsequent laparoscopic right hemihepatectomy. The entire process is described step-by-step, and only free-to-use and mostly open-source software was used. Results: As a result, a transparent, full-sized liver model with visible vessels and colorectal metastasis was created for under $150, which-taking into account 3D printer prices-is much cheaper than models presented in previous research papers. Conclusions: The increased accessibility of 3D models for physicians before complex laparoscopic surgical procedures such as hepatic resections could lead to beneficial breakthroughs in these sophisticated surgeries, as many reports show that these models reduce operative time and improve short term outcomes. [ABSTRACT FROM AUTHOR]

Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of B-cell and T-cell neoplasms. Diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, accounts for around 30-40% of NHL cases. However, primary hepatic location of NHLs is rare and constitutes 0.01% of all NHL cases. Due to this rarity and a lack of large randomized trails, it is still unclear what treatment should be used for primary hepatic DLBCLs. In this study, we report of a female patient with primary hepatic DLBCL who was successfully treated with neoadjuvant chemotherapy and surgery. We also shortly review the literature regarding surgical treatments for primary GI tract NHLs. Taking into account our experience and the current literature, surgical treatment with postoperative chemotherapy seems to be a feasible option for patients with focal primary hepatic DLBCLs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the increase in the future liver remnant (FLR) in patients prior to liver resection who underwent portal vein embolization, regarding applied embolization material. Another aim is to evaluate the interobserver variability of volumetric analysis for the measurement of volumes. Methods: The total of 36 patients prior planned liver resection who underwent portal vein embolization in the University Hospital Brno were included in this retrospective study. Volumetric analysis was performed on CT/MRI before and after the procedure by two independent radiologists. The interobserver variability was determined by using Pearson and Wilcoxon correlation coefficient. The correlation between the increase in FLR and applied embolization material was determined by using pair t-test, as well as for the determination of correlation between the increase in FLR and recanalization of v. portae. Results: The portal vein embolization was successful in all the patients with average increase in FLR by 4% for S2+3, by 8% for left liver lobe. Recanalization of v.portae occurred in 18 patients. The volume of S2+3 increased in average by 30%, the volume of left lobe by 30%. Major increase in FLR was proved using the permanent embolization agents (p = 0.014), the influence of recanalization was not proved (p = 0.056). Volumetric analysis shows to be a method of assessment with a very low interobserver variability; the Pearson correlation coefficient is > 0.9 (p < 0.001) for all the parameters. Conclusion: In case of insufficient value of FLR before liver resection, it is possible to increase it with the portal vein embolization. The permanent embolization agents appear to be eligible. The volumetric analysis can be used for the determination of FLR, since it is a method with significantly low interobserver variability. [ABSTRACT FROM AUTHOR]

Background: Since biliary variations are commonly seen, our aims are to clarify these insidious variations and discuss their surgicopathologic implications for Bismuth-Corlette (BC) type IV hilar cholangiocarcinoma (HC) applied to hemihepatectomy.Methods: Three-dimensional images of patients with distal bile duct obstruction (n = 97) and advanced HC (n = 79) were reconstructed and analyzed retrospectively. Normal biliary confluence pattern was defined as the peripheral segment IV duct (B4) joining the common trunk of segment II (B2) and segment III (B3) ducts to form the left hepatic duct (LHD) that then joined the right hepatic duct (RHD). The lengths from left and right secondary biliary ramifications to the right side of the umbilical portion of the left portal vein (Rl-L) and the cranio-ventral side of the right portal vein (Rr-R) were measured, respectively, and compared with the resectable bile duct length in HCs. Surgicopathologic findings were compared between different BC types.Results: The resectable bile duct length in right hemihepatectomy for eradication of type IV tumors was significantly longer than the Rl-L length in normal biliary configuration (17.4 ± 1.8 and 10.3 ± 3.4 mm, respectively, p < 0.001), and type III variation (B2 joining the common trunk of B3 and B4) was the predominant configuration (53.8%). The resectable length in left hemihepatectomy for eradication of type IV tumors was comparable with the Rr-R length in RHD absent cases (15.2 ± 2.5 and 16.4 ± 2.6 mm, respectively, p = 0.177) but significantly longer than that in normal configuration (p < 0.001). The estimated length was 8.5 ± 2.0 mm in unresectable cases. There was no significant difference between type III and IV tumors, except for the rate of nodal metastasis (29.7 and 76.0%, respectively, p < 0.001).Conclusion: Hemihepatectomy might be selected for curative-intent resection of BC type IV tumors considering the advantageous biliary variations, whereas anatomical trisegmentectomy is recommended for the resectable bile duct length less than 10 mm. Biliary variations might result in excessive classification of BC type IV but require validation on further study. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to analyse the safety, feasibility and survival outcomes of our treatment of perihilar cholangiocarcinoma (PHC) since the introduction of more aggressive approaches (en bloc, vascular and extended liver resections) in 2007. Patients and methods: From July 2007 to December 2014, 32 consecutive patients with PHC underwent surgery with curative intent. Surgery with resection and reconstruction of the portal vein bifurcation and right hepatic artery was performed if necessary for a complete removal of the tumour. Perioperative data and postoperative histological findings, tumour recurrence rates and survival rates were recorded. Seventeen (53%) of the patients presented with stage IIIb or IV according to the UICC classification system. Results: The 5-year survival rate in our series was 45%, and this percentage increased to 65% when patients with advanced stage cancer (stage IIIb or higher) were excluded. We performed 3 arterials and 23 portal vein reconstruction. Twelve patients underwent extended hemihepatectomy. We achieved cancer-free margins in 19 patients (60%). Tumour stage and nodal involvement were the most important prognostic factors. The perioperative morbidity and mortality rates of this cohort were 72% (23) and 15.6% (5), respectively; these results were similar to data published by other groups. Conclusions: An aggressive approach involving en bloc or extended liver resection combined with vascular reconstruction provides acceptable morbidity and mortality and increases the 5-year survival rate of PHC. [ABSTRACT FROM AUTHOR]