Hepatectomy remains the only curative treatment for many primary and secondary liver cancers.Portal vein embolization(PVE) has been used to increase the volume of the future liver remnant and thus lower the risk of sm...Hepatectomy remains the only curative treatment for many primary and secondary liver cancers.Portal vein embolization(PVE) has been used to increase the volume of the future liver remnant and thus lower the risk of small-for-size syndrome and postoperative liver failure.This technique has proven its safety,with a low post-procedure morbidity rate.Here,we describe a very rare case in which a young patient suffered a glue embolism to the right atrial cavity following PVE in preparation for a major hepatectomy for colorectal metastasis.The foreign body was withdrawn from the heart with a femoral,percutaneous device and trapped against the wall of the femoral vein with a self-expanding metal stent.Our report shows that this previously unknown complication of PVE can be resolved without recourse to sternotomy and open heart surgery.展开更多
Background:Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma(HCC).Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC.The obje...Background:Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma(HCC).Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC.The objectives of this study were to determine the prognostic factors of recurrence-free survival(RFS)and overall survival(OS)and to develop a prognostication algorithm for non-cirrhotic HCC.Methods:French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis:F0,F1 or F2 fibrosis.Results:A total of 467 patients were included in 11 centers from 2010 to 2018.Non-cirrhotic liver had a fibrosis score of F0(n=237,50.7%),F1(n=127,27.2%)or F2(n=103,22.1%).OS and RFS at 5 years were 59.2%and 34.5%,respectively.In multivariate analysis,microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS(P<0.005).Stratification based on RFS provided an algorithm based on size(P=0.013)and number(P<0.001):2 HCC with the largest nodule≤10 cm(n=271,Group 1);2 HCC with a nodule>10 cm(n=176,Group 2);>2 HCC regardless of size Conclusions:We developed a prognostication algorithm based on the number(≤or>2)and size(≤or>10 cm),which could be used as a treatment decision support concerning the need for perioperative therapy.In case of bifocal HCC,surgery should not be a contraindication.展开更多
Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been introduced in 2012 as an innovative surgical option that offers patients curative resection in otherwise nonresectable tumors....Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been introduced in 2012 as an innovative surgical option that offers patients curative resection in otherwise nonresectable tumors.Considering the high morbi-mortality rates and poor oncologic outcome in the early experience,indications of ALPPS have been restricted to young patients with colorectal liver metastases(CRLM)following the first report on the international ALPPS registry(1).ALPPS further gained in safety after the first International ALPPS Meeting held in 2015(2)in Hamburg,which prompted surgeons to better patient selection by chemotherapy(3),technical refinements toward less invasive ALPPS procedures(4),and better inter-stage decision making(5).展开更多
Liver regeneration after a major hepatectomy(MH)is crucial for the patient postoperative recovery,with the first postoperative month(1M)being a critical period for the liver regeneration course.The risk of post hepate...Liver regeneration after a major hepatectomy(MH)is crucial for the patient postoperative recovery,with the first postoperative month(1M)being a critical period for the liver regeneration course.The risk of post hepatectomy liver failure(PHLF),which is the leading cause of death,is usually anticipated in the preoperative period by the measurement of the future remnant liver volume(RLV)via computed tomography(CT)with volumetry.展开更多
文摘Hepatectomy remains the only curative treatment for many primary and secondary liver cancers.Portal vein embolization(PVE) has been used to increase the volume of the future liver remnant and thus lower the risk of small-for-size syndrome and postoperative liver failure.This technique has proven its safety,with a low post-procedure morbidity rate.Here,we describe a very rare case in which a young patient suffered a glue embolism to the right atrial cavity following PVE in preparation for a major hepatectomy for colorectal metastasis.The foreign body was withdrawn from the heart with a femoral,percutaneous device and trapped against the wall of the femoral vein with a self-expanding metal stent.Our report shows that this previously unknown complication of PVE can be resolved without recourse to sternotomy and open heart surgery.
文摘Background:Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma(HCC).Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC.The objectives of this study were to determine the prognostic factors of recurrence-free survival(RFS)and overall survival(OS)and to develop a prognostication algorithm for non-cirrhotic HCC.Methods:French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis:F0,F1 or F2 fibrosis.Results:A total of 467 patients were included in 11 centers from 2010 to 2018.Non-cirrhotic liver had a fibrosis score of F0(n=237,50.7%),F1(n=127,27.2%)or F2(n=103,22.1%).OS and RFS at 5 years were 59.2%and 34.5%,respectively.In multivariate analysis,microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS(P<0.005).Stratification based on RFS provided an algorithm based on size(P=0.013)and number(P<0.001):2 HCC with the largest nodule≤10 cm(n=271,Group 1);2 HCC with a nodule>10 cm(n=176,Group 2);>2 HCC regardless of size Conclusions:We developed a prognostication algorithm based on the number(≤or>2)and size(≤or>10 cm),which could be used as a treatment decision support concerning the need for perioperative therapy.In case of bifocal HCC,surgery should not be a contraindication.
文摘Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been introduced in 2012 as an innovative surgical option that offers patients curative resection in otherwise nonresectable tumors.Considering the high morbi-mortality rates and poor oncologic outcome in the early experience,indications of ALPPS have been restricted to young patients with colorectal liver metastases(CRLM)following the first report on the international ALPPS registry(1).ALPPS further gained in safety after the first International ALPPS Meeting held in 2015(2)in Hamburg,which prompted surgeons to better patient selection by chemotherapy(3),technical refinements toward less invasive ALPPS procedures(4),and better inter-stage decision making(5).
文摘Liver regeneration after a major hepatectomy(MH)is crucial for the patient postoperative recovery,with the first postoperative month(1M)being a critical period for the liver regeneration course.The risk of post hepatectomy liver failure(PHLF),which is the leading cause of death,is usually anticipated in the preoperative period by the measurement of the future remnant liver volume(RLV)via computed tomography(CT)with volumetry.
