Objective To report our experience of retrograde hepatectomy in 244 cases of difficultly resected liver cancer. Methods Large, poor-exposure and inferior vena cava (IVC)-involving liver cancers that were difficult t...Objective To report our experience of retrograde hepatectomy in 244 cases of difficultly resected liver cancer. Methods Large, poor-exposure and inferior vena cava (IVC)-involving liver cancers that were difficult to remove by classical hepatectomy, have been resected successfully by retrograde hepatectomy combined with vascular surgical techniques in 244 patients (group A). Thirty one patients with similar circumstances undergoing classical hepatectomy duing the same period served as controls (group B). Results There were no perioperative mortalities in both groups. The comparison between group A and group B, the estimated intraoperative blood loss was 1290±998 ml versus 2286±1363 ml, post-operative pleural effusions occurred in 26/244 versus 10/31, ascites in 72/244 versus 19/31, moderate to severe jaundice in 14/244 versus 5/31, effusion in the operative area in 17/244 versus 7/31, subphrenic infection in 3/244 versus 1/31, bile leakage in 2/244 versus 1/31, wound infection in 3/244 versus 1/31, respectively. The time until ALT normalizaton in the groups A and B was 13.8±5.1 days and 18.9±8.9 days respectively. The difference between the two groups were statistically significant (P<0.01). Conclusion Retrograde hepatectomy is a safe and effective method for difficultly resected liver cancer. Key words cancer - liver - liver surgery - retrograde展开更多
AIM： To evaluate the efficacy of the two-surgeon technique with the liver hanging maneuver （LHM） for hepatectomies in pediatric patients with hepatoblastoma. METHODS： Three pediatric patients with hepatoblastoma w...AIM： To evaluate the efficacy of the two-surgeon technique with the liver hanging maneuver （LHM） for hepatectomies in pediatric patients with hepatoblastoma. METHODS： Three pediatric patients with hepatoblastoma were enrolled in this study. Two underwent right hemi-hepatectomies and one underwent a left hemihepatectomy using the two-surgeon technique by means of saline-linked electric cautery （SLC） and the Cavitron Ultrasonic Surgical Aspirator （CUSA; Valleylab, Boulder, CO） and the LHM. RESULTS： The mean operative time during the parenchymal transections was 50 rain and the mean blood loss was 235 g. There was no bile leakage from the cut surface after surgery. No macroscopic or microscopic-positive margins were observed in the hepatic transections. CONCLUSION： The two-surgeon technique using SLC and CUSA with the LHM is applicable to even pediatric patients with hepatoblastoma.展开更多
The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the y...The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.展开更多
Hepato-pancreato-biliary(HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/advanced stages because of the lack of a systemic surveillance program in China. This situation creat...Hepato-pancreato-biliary(HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/advanced stages because of the lack of a systemic surveillance program in China. This situation creates many technical challenges for surgeons and increases the incidence of postoperative complications. Therefore, Dr. Xiao-Ping Chen has made many important technical improvements, such as Chen's hepatic portal occlusion method, the anterior approach for liver resection of large HCC tumors, the modified technique of Belghiti's liver-hanging maneuver, inserting biliary-enteric anastomosis technique, and invaginated pancreaticojujunostomy with transpancreatic U-sutures. These techniques are simple, practical, and easy to learn. Owing to these advantages, complicated surgical procedures can be simplified, and the curative effects are greatly improved. These improved techniques have been widely applied in China and will benefit many additional patients. In this review, we introduce our experience of surgically treating intermediate/advanced hepatocellular carcinoma(HCC), hilar cholangiocarcinoma(HC), and pancreatic carcinoma, mainly focusing on technical innovations established by Dr. Chen in HPB surgery.展开更多
文摘Objective To report our experience of retrograde hepatectomy in 244 cases of difficultly resected liver cancer. Methods Large, poor-exposure and inferior vena cava (IVC)-involving liver cancers that were difficult to remove by classical hepatectomy, have been resected successfully by retrograde hepatectomy combined with vascular surgical techniques in 244 patients (group A). Thirty one patients with similar circumstances undergoing classical hepatectomy duing the same period served as controls (group B). Results There were no perioperative mortalities in both groups. The comparison between group A and group B, the estimated intraoperative blood loss was 1290±998 ml versus 2286±1363 ml, post-operative pleural effusions occurred in 26/244 versus 10/31, ascites in 72/244 versus 19/31, moderate to severe jaundice in 14/244 versus 5/31, effusion in the operative area in 17/244 versus 7/31, subphrenic infection in 3/244 versus 1/31, bile leakage in 2/244 versus 1/31, wound infection in 3/244 versus 1/31, respectively. The time until ALT normalizaton in the groups A and B was 13.8±5.1 days and 18.9±8.9 days respectively. The difference between the two groups were statistically significant (P<0.01). Conclusion Retrograde hepatectomy is a safe and effective method for difficultly resected liver cancer. Key words cancer - liver - liver surgery - retrograde
文摘AIM： To evaluate the efficacy of the two-surgeon technique with the liver hanging maneuver （LHM） for hepatectomies in pediatric patients with hepatoblastoma. METHODS： Three pediatric patients with hepatoblastoma were enrolled in this study. Two underwent right hemi-hepatectomies and one underwent a left hemihepatectomy using the two-surgeon technique by means of saline-linked electric cautery （SLC） and the Cavitron Ultrasonic Surgical Aspirator （CUSA; Valleylab, Boulder, CO） and the LHM. RESULTS： The mean operative time during the parenchymal transections was 50 rain and the mean blood loss was 235 g. There was no bile leakage from the cut surface after surgery. No macroscopic or microscopic-positive margins were observed in the hepatic transections. CONCLUSION： The two-surgeon technique using SLC and CUSA with the LHM is applicable to even pediatric patients with hepatoblastoma.
文摘The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.
文摘Hepato-pancreato-biliary(HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/advanced stages because of the lack of a systemic surveillance program in China. This situation creates many technical challenges for surgeons and increases the incidence of postoperative complications. Therefore, Dr. Xiao-Ping Chen has made many important technical improvements, such as Chen's hepatic portal occlusion method, the anterior approach for liver resection of large HCC tumors, the modified technique of Belghiti's liver-hanging maneuver, inserting biliary-enteric anastomosis technique, and invaginated pancreaticojujunostomy with transpancreatic U-sutures. These techniques are simple, practical, and easy to learn. Owing to these advantages, complicated surgical procedures can be simplified, and the curative effects are greatly improved. These improved techniques have been widely applied in China and will benefit many additional patients. In this review, we introduce our experience of surgically treating intermediate/advanced hepatocellular carcinoma(HCC), hilar cholangiocarcinoma(HC), and pancreatic carcinoma, mainly focusing on technical innovations established by Dr. Chen in HPB surgery.
