AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard mode...AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.展开更多
AIM:To evaluate the short-and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).METHODS:We retrospectively analyzed 114 consecutive patients with HCC,originating from the caudate lo...AIM:To evaluate the short-and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).METHODS:We retrospectively analyzed 114 consecutive patients with HCC,originating from the caudate lobe,who underwent resection between January 2001 and January 2007.Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.RESULTS:Overall mortality and morbidity were 0% and 18%,respectively.After a median follow-up of 31 mo (interquartile range,11-66 mo),tumor recurrence had occurred in 76 patients (66.7%).The 1-,3-,and 5-year disease-free survival rates were 65.7%,38.1%,and 18.4%,respectively.The 1-,3-,and 5-year overall survival rates were 76.1%,54.7%,and 31.8%,respectively.Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%,P=0.01),liver cirrhosis (12.3% vs 47.9%,P=0.03),surgical margin (18.5% vs 54.6%,P=0.04),vascular invasion (37.9% vs 23.2%,P=0.04) and extended caudate resection (42.1% vs 15.4%,P=0.04) were related to poorer long-term survival.Multivariate analysis showed that only subsegmental location of the tumor,liver cirrhosis and surgical margin were significant independent prognostic factors.CONCLUSION:Hepatectomy was an effective treatment for HCC in the caudate lobe.The subsegmental location of the tumor,liver cirrhosis and surgical margin affected long-term survival.展开更多
BACKGROUND: Caudate lobectomy is now considered to be the most appropriate surgical treatment for benign tumors in the caudate lobe. But how to resect the caudate lobe safely is a major challenge to current liver surg...BACKGROUND: Caudate lobectomy is now considered to be the most appropriate surgical treatment for benign tumors in the caudate lobe. But how to resect the caudate lobe safely is a major challenge to current liver surgery and requires further study. This research aimed to analyze the perioperative factors and explore the surgical technique associated with liver resection in hepatic caudate lobe hemangioma. METHODS: Eleven consecutive patients with symptomatic hepatic hemangiomas undergoing caudate lobectomy from November 1990 to August 2009 at our hospital were investigated retrospectively. All patients were followed up to the present. RESULTS: In this series, 9 were subjected to isolated caudate lobectomy and 2 to additional caudate lobectomy (in addition to left lobe and right lobe resection, respectively). The average maximum diameter of tumors was 9.65+/-4.11 cm. The average operative time was 232.73+/-72.16 minutes. Five of the 11 patients required transfusion of blood or blood products during surgery. Ascites occurred in I patient, pleural effusion in the perioperative period in 1, and multiple organ failure in 1 on the 6th day after operation as a result of massive intraoperative blood loss, who had received multiple transcatheter hepatic arterial embolization preoperatively. The alternating left-right-left approach produced the best results for caudate lobe surgery in most of our cases. All patients who recovered from the operation are living well and asymptomatic. CONCLUSIONS: For large hemangioma of the caudate lobe, surgery is only recommended for symptomatic cases. Caudate lobectomy of hepatic hemangioma can be performed safely, provided it is carried out with optimized perioperative management and innovative surgical technique.展开更多
AIM： To find the precautions against the safety in caudate lobe resection. METHODS： The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrosp...AIM： To find the precautions against the safety in caudate lobe resection. METHODS： The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe： （1） selection of appropriate skin incision to obtain excellent exposure of operative field; （2） adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; （3） preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; （4） selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate Iobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate Iobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral Iobectomy for 2 cases and caudate Iobectomy alone for 6 cases. RESULTS： Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation. CONCLUSION： Caudate Iobectomy for liver cancer in candate lobe can be safely performed with the above procedures.展开更多
BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using r...BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (I donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume-of the remnant liver exceeds 35% of the total liver volume.展开更多
目的比较尾状叶肝细胞癌与非尾状叶肝细胞癌手术切除治疗效果的差异,为提高肝细胞癌的手术切除治疗效果提供临床依据。方法选择该院2008年7月—2013年10月42例尾状叶肝细胞癌切除术患者作为研究对象,并选择同期42例非尾状叶肝细胞癌患...目的比较尾状叶肝细胞癌与非尾状叶肝细胞癌手术切除治疗效果的差异,为提高肝细胞癌的手术切除治疗效果提供临床依据。方法选择该院2008年7月—2013年10月42例尾状叶肝细胞癌切除术患者作为研究对象,并选择同期42例非尾状叶肝细胞癌患者作为对照。对两组患者的临床病理学特征、手术情况、术后复发率及生存期进行比较分析。结果尾状叶肝细胞癌患者有较长的手术时间(平均192.9 min vs 128.7 min)、较长的血管阻断时间(平均32.5 min vs 24.7 min)、较多的术中出血(平均为827.6 mL vs 431.4 mL),两组的并发症发生率没有显著差异(28.6%vs 21.4%)。两组患者均无院内死亡。尾状叶肝细胞癌组中位随访期为42.3个月,复发率为56.7%;非尾状叶肝细胞癌组中位随访期为43.3个月,复发率为41%。两组患者肿瘤复发率差异具有统计学意义,在肿瘤复发模式上无显著差异。尾状叶肝细胞癌患者1、3、5年总生存率分别为73.8%、51.9%和28.3%,对照组分别为84.2%、71.5%和49.2%(P=0.000 1)。尾状叶肝细胞癌患者1、3、5年无瘤生存率分别为60.9%、33.8%和17.6%,对照组为72.9%、60.3%和41.7%(P=0.001 2)。两组患者总生存率与无瘤生存率差异显著。结论手术切除治疗尾状叶肝细胞癌与非尾状叶肝细胞癌有着显著不同的疗效,其可能原因与尾状叶肝细胞癌手术切缘不足、术中较多出血等有关。展开更多
文摘AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.
文摘AIM:To evaluate the short-and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).METHODS:We retrospectively analyzed 114 consecutive patients with HCC,originating from the caudate lobe,who underwent resection between January 2001 and January 2007.Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.RESULTS:Overall mortality and morbidity were 0% and 18%,respectively.After a median follow-up of 31 mo (interquartile range,11-66 mo),tumor recurrence had occurred in 76 patients (66.7%).The 1-,3-,and 5-year disease-free survival rates were 65.7%,38.1%,and 18.4%,respectively.The 1-,3-,and 5-year overall survival rates were 76.1%,54.7%,and 31.8%,respectively.Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%,P=0.01),liver cirrhosis (12.3% vs 47.9%,P=0.03),surgical margin (18.5% vs 54.6%,P=0.04),vascular invasion (37.9% vs 23.2%,P=0.04) and extended caudate resection (42.1% vs 15.4%,P=0.04) were related to poorer long-term survival.Multivariate analysis showed that only subsegmental location of the tumor,liver cirrhosis and surgical margin were significant independent prognostic factors.CONCLUSION:Hepatectomy was an effective treatment for HCC in the caudate lobe.The subsegmental location of the tumor,liver cirrhosis and surgical margin affected long-term survival.
文摘BACKGROUND: Caudate lobectomy is now considered to be the most appropriate surgical treatment for benign tumors in the caudate lobe. But how to resect the caudate lobe safely is a major challenge to current liver surgery and requires further study. This research aimed to analyze the perioperative factors and explore the surgical technique associated with liver resection in hepatic caudate lobe hemangioma. METHODS: Eleven consecutive patients with symptomatic hepatic hemangiomas undergoing caudate lobectomy from November 1990 to August 2009 at our hospital were investigated retrospectively. All patients were followed up to the present. RESULTS: In this series, 9 were subjected to isolated caudate lobectomy and 2 to additional caudate lobectomy (in addition to left lobe and right lobe resection, respectively). The average maximum diameter of tumors was 9.65+/-4.11 cm. The average operative time was 232.73+/-72.16 minutes. Five of the 11 patients required transfusion of blood or blood products during surgery. Ascites occurred in I patient, pleural effusion in the perioperative period in 1, and multiple organ failure in 1 on the 6th day after operation as a result of massive intraoperative blood loss, who had received multiple transcatheter hepatic arterial embolization preoperatively. The alternating left-right-left approach produced the best results for caudate lobe surgery in most of our cases. All patients who recovered from the operation are living well and asymptomatic. CONCLUSIONS: For large hemangioma of the caudate lobe, surgery is only recommended for symptomatic cases. Caudate lobectomy of hepatic hemangioma can be performed safely, provided it is carried out with optimized perioperative management and innovative surgical technique.
文摘AIM： To find the precautions against the safety in caudate lobe resection. METHODS： The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe： （1） selection of appropriate skin incision to obtain excellent exposure of operative field; （2） adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; （3） preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; （4） selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate Iobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate Iobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral Iobectomy for 2 cases and caudate Iobectomy alone for 6 cases. RESULTS： Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation. CONCLUSION： Caudate Iobectomy for liver cancer in candate lobe can be safely performed with the above procedures.
文摘BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (I donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume-of the remnant liver exceeds 35% of the total liver volume.
文摘目的比较尾状叶肝细胞癌与非尾状叶肝细胞癌手术切除治疗效果的差异,为提高肝细胞癌的手术切除治疗效果提供临床依据。方法选择该院2008年7月—2013年10月42例尾状叶肝细胞癌切除术患者作为研究对象,并选择同期42例非尾状叶肝细胞癌患者作为对照。对两组患者的临床病理学特征、手术情况、术后复发率及生存期进行比较分析。结果尾状叶肝细胞癌患者有较长的手术时间(平均192.9 min vs 128.7 min)、较长的血管阻断时间(平均32.5 min vs 24.7 min)、较多的术中出血(平均为827.6 mL vs 431.4 mL),两组的并发症发生率没有显著差异(28.6%vs 21.4%)。两组患者均无院内死亡。尾状叶肝细胞癌组中位随访期为42.3个月,复发率为56.7%;非尾状叶肝细胞癌组中位随访期为43.3个月,复发率为41%。两组患者肿瘤复发率差异具有统计学意义,在肿瘤复发模式上无显著差异。尾状叶肝细胞癌患者1、3、5年总生存率分别为73.8%、51.9%和28.3%,对照组分别为84.2%、71.5%和49.2%(P=0.000 1)。尾状叶肝细胞癌患者1、3、5年无瘤生存率分别为60.9%、33.8%和17.6%,对照组为72.9%、60.3%和41.7%(P=0.001 2)。两组患者总生存率与无瘤生存率差异显著。结论手术切除治疗尾状叶肝细胞癌与非尾状叶肝细胞癌有着显著不同的疗效,其可能原因与尾状叶肝细胞癌手术切缘不足、术中较多出血等有关。
