Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Bile leakage is a common complication of hepatocellular carcinoma (HCC) after hepatectomy, which affects the prognosis and medical quality. It is emphasized that taking preventive measures according to the etiology and related risk factors could help to reduce the incidence of bile leakage, improve the quality and safety of HCC diagnosis and treatment, and achieve the main indicators of HCC quality control in the 2022 version of National Cancer Center. In this review, combined with the team of Peng’s leakage test technology research and clinical practice, brief talk about personal experience.
ObjectiveTo investigate the role of endoplasmic reticulum stress in liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).MethodsSeventy-two C57bl/6 mice were randomly divided into ALPPS group, portal vein ligation group (PVL group), and sham operation group (Sham group), 24 mice in each group. And then one-stage ALPPS operation, simple PVL, and sham operation will be performed. Six mice were randomized selected of the three groups on the 1st, 2nd, 4th, and 7th day after surgery, respectively, the liver weight to body weight ratio (FLR/BW) of each group was measured, and the liver tissues were taken for immunohistochemical staining to calculate the proportion of Ki-67 positive cells, Western blot was used to detect the expression levels of X-box binding protein 1 (XBP1) and inositol-requiring enzyme 1α (IRE1α) proteins.Results① FLR/BW: On the 4th day and the 7th day after operation, the FLR/BW of the Sham group, PVL group, and ALPPS group increased in sequence at the same time, and the difference between the three groups was statistically significant (P<0.05). ② Ki-67 positive cell ratio: On the 2nd day after operation, the ratio of Ki-67 positive cells in the Sham group, PVL group, and ALPPS group increased sequentially, and the difference between the two groups was statistically significant (P<0.05). On the 4th day after operation, the ratio of Ki-67 positive cells in the PVL group and the ALPPS group were still higher than that of the Sham group (P<0.05). ③ Expression levels of XBP1 and IRE1α: On the 2nd and 4th postoperative day, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group and the PVL group (P<0.05). On the 7th day after surgery, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group (P<0.05), while compared with the PVL group, the expression level of XBP1 in the ALPPS group was still higher (P<0.05).ConclusionsALPPS-induced liver regeneration is more advantageous than traditional PVL in mice. It may be attributed to the obvious endoplasmic reticulum stress activation after ALPPS leading to the up-regulation of IRE1α-XBP1 expression, which is involved in the regulation of hepatocyte cell cycle and promotes hepatocyte proliferation, thus promoting rapid liver regeneration.
ObjectiveTo explore the clinical application of in vivo hepatectomy with preservation of retrohepatic inferior vena cava (IVC) for hepatic alveolar echinococcosis (HAE) with the invasion of IVC. MethodsThe clinicopathologic data of a complicated HAE patient with large lesion (maximum cross-section 12.6 cm×9.6 cm), infiltrative growth, unclear boundary with surrounding tissues, and invasions of diaphragm and IVC (invasion length up to 4.6 cm) admitted to the Department of Liver Surgery in the West China Hospital of Sichuan University in December 2021 was retrospectively collected. The three-dimensional reconstruction of the liver model was performed by Mimics Medical 21.0 software before operation. The invading IVC of the right liver lesion was measured and the resection was simulated. During the operation, the HAE lesion and the affected IVC were gradually separated from IVC by the hemostatic forceps, and the residual lesions were gradually removed. ResultsIn this patient, the HAE lesion of right liver was resected, the IVC was entirely preserved, and the resection of liver was consistent with the preoperative three-dimensional reconstruction plan. The operation time was 275 min, the bleeding was approximately 500 mL. On the first day after the operation, the alanine aminotransferase and aspartate aminotransferase were increased, no obvious abnormalities were observed in the plasma albumin and bilirubin, the patient recovered and was discharged on the seventh day after the operation. No complications occurred after the operation, and no recurrence or metastasis of HAE was observed during follow-up period. ConclusionsHepatectomy with preservation of retrohepatic IVC for HAE with invasion of IVC is safe and effective. Taking albendazole regularly after surgery will help maintain disease-free survival.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.
Objective To systematically evaluate the efficiency of laparoscopic hepatectomy（LH） and conventionalopen hepatectomy （OH）in patients with hepatocellular carcinoma （HCC）. Methods The literatures about the therap-eutic effect of LH and OH on hepatocellular carcinoma were collected from PubMed， Chinese Journal Full-text Database （CJFD）， Wanfang Database， China Doctor/Master Dissertations Full-text Database （CDMD）， and China Proceedings of Conference Full-text Database （CPCD）from 2000 to 2011. RevMan 5.0 software was used for data analysis. Results Eleven controlled clinical trials were included in this analysis. These studies included a total of 781 patients：325 treated with LH and 456 treated with OH. The results of meta-analysis showed that LH group had shorter operation time〔WMD=-20.85， 95% CI （-29.54， -12.16）， P＜0.000 01〕， less operative blood loss 〔SMD=-0.42，95% CI（-0.65，-0.19）， P=0.000 4〕， a lower postoperative morbidity rate 〔OR=0.43，95% CI （0.28，0.65），P＜0.000 1〕， and shorter hospitalization days 〔WMD=-4.32，95％ CI （-6.29，-2.34），P＜0.000 1〕 than OH group. There was no significant difference in postoperative recurrence （P=0.80）， overall survival in 1-year （P=0.98）， 3-year （P=0.41）， and 5-year （P=0.12）， and in disease-free survival in 1-year （P=0.15）， 3-year （P=0.62）， and 5-year （P=0.99）between the two groups. Conclusions For the patients with hepatocellular carcinoma localized to the CouinaudⅡ，Ⅲ，Ⅳ，Ⅴ，and Ⅵ segments with a maximum lesion size of 5cm， as well as the tumor has no effect on the exposure of blood vessel of the first and second hepatic portal， and the liver functions are classified as Child B or A high grade， the laparoscopic liver resection is priority considered in the conditions allow.
Objective To approach whether the postoperative recovery processes of the living donors and hepaticpatients after right hepatectomy is similar. Methods The clinical data of consecutive cases from 2009 to 2010 in our liver transplantation center was retrospectively analyzed， including 40 cases who donated the right lobe without the middlehepatic vein （living donor liver transpalntation-donor group， abbreviated as LDLT-D group） and 80 hepatic patients forright hepatectomy， in which 40 cases were hepatic patients without cirrhosis （liver disease-noncirrhosis group， abbreviatedas LD-NC group） and 40 cases were hepatic patients with cirrhosis （liver disease-with cirrhosis group， abbreviated asLD-WC group）. Preoperative liver function and general clinical data， intraoperative blood loss and transfusion， postoper-ative liver function， and complications were statistically analyzed in this study. Results The preoperative parameters of three groups were comparable. LDLT-D group experienced more intraoperative bleeding than LD-NC group 〔（765±411） mL vs. （584±242） mL， P=0.008〕， and was similar to LD-WC group 〔（666±224） mL， P=0.136〕. However， the average amount of blood transfusion products was similar among the 3 groups （P=0.108）. The levels of total bilirubin and INR of LDLT-D group were higher than LD-NC group and LD-WC group on the first and third day after operation （P＜0.05）. The levels of ALT and AST of LD-WC group were higher than LDLT-D group and LD-NC group （P＜0.05）. The overall postoperative surgical morbidity incidence of LDLT-D group， LD-NC group， and LD-WC group were 30.0%（12/40）， 27.5% （11/40）， and 37.5% （15/40） respectively， and were not statistically significant （P=0.606）. However， the ClavienⅢcomplication rate of LD-WC group was higher than LDLT-D group and LD-NC group 〔27.5% （11/40） vs. 7.5%（3/40） and 10.0% （4/40）， P=0.024〕. Conclusions Liver function of living donors is injured more seriously during the early postoperative period. The total complication rates after right hepatectomy are similar among the living liver donation and hepatic patients with or without cirrhosis. However， the serious complication rate of cirrhotic liver recipients is higher than living donors and patients without cirrhosis.
Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966~2008.3), EMBASE (1966~2008.3), CBM (1979~2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks JJ’s evaluation criterion. Meta–analysis was done using the Cochrane collaboration’s Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta–analysis showed that: (1) Four studies (n=198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%Cl (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), Plt;0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= – 1.56, 95%Cl (– 2.39, – 0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= – 3.89, 95%CI (– 5.54, – 2.23), Plt;0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= – 1.54, 95%Cl (– 207, – 1.01), Plt;0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
To evaluate the biological tolerance of the human liver to prolonged warm ischemia, 20 patients who underwent liver resections with hepatic inflow occlusion are reported. Biopsy of liver were performed during and after consecutive periods of hepatic ischemia, and speciments were observed under light and electron microscope. The results showed that hepatic vascular occlusion for ＜30 min, resulted in atotissular temporary but reversible pathologic and ultrastructural changes in liver, even patients with liver cirrhosis had better recovery from the operation when the hepatic ischemia was lengthen up to 40 min.
ObjectiveTo understand the incidence and mechanism of posthepatectomy acute pancreatitis (PHAP) after liver resection, and to explore diagnosis, treatment, and preventive strategies to enhance prognosis for the patients with PHAP. MethodThe literature on studies relevant PHAP both domestically and internationally was retrieved and reviewed. ResultsThe incidence rate of PHAP was approximately 0.7% by the literature. The exact etiology was still unclear. According to the existing research results, it was speculated that the pathogenesis might be related to the portal vein congestion, reactive oxygen species, surgical trauma, and other factors. At present, there were no comprehensive guidelines for the diagnosis and treatment of PHAP after liver resection both domestically and internationally. The diagnosis was mainly based on the clinical manifestations, early signs and symptoms, biochemical examination and imaging evaluation. The treatment principle of the PHAP was similar to that of common acute pancreatitis. The symptomatic supportive treatment was performed for the patients with mild to moderate PHAP, while the surgical treatment and minimally invasive surgery were chosen for the severe PHAP. The best way prevented for PHAP was the preoperative comprehensive evaluation of patients, and quit smoking and drinking, and so on. The careful operation should be performed during the surgical process to minimize portal vein congestion and reduce reactive oxygen species in blood vessels.The blood biochemistry, hematuric amylase, pancreatic function, and relevant infection indicators should be closely monitored after surgery, and abdominal ultrasound should be repeated several times to achieve early identification and timely treatment. ConclusionsAlthough the incidence rate of PHAP is not high, it is a serious surgical complication. The prevention, early detection, and early treatment should be strengthened for PHAP, and we should focuse on earlier and more accurate prediction model in future.