Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients

BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma.The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.METHODS A retrospective multicentric study was performed enrolling 77 patients age≥70-years-old with single hepatocellular carcinoma(≤30 mm),located in posterosuperior segments(4a,7,8).Patients were divided into liver resection and radiofrequency ablation groups and preoperative,peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.RESULTS After propensity score matching,twenty-six patients were included in each group.Operative time and overall postoperative complications were higher in the resection group compared to the ablation group(165 min vs 20 min,P<0.01;54%vs 19%P=0.02 respectively).A median hospital stay was significantly longer in the resection group than in the ablation group(7.5 d vs 3 d,P<0.01).Ninety-day mortality was comparable between the two groups.There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1,3,and 5 years.CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay,better quality of life and does not modify the overall and disease-free survival.

Successful robotic radical resection of hepatic echinococcosis located in posterosuperior liver segments

BACKGROUND Radical resection is an important treatment method for hepatic echinococcosis.The posterosuperior segments of the liver remain the most challenging region for laparoscopic or robotic hepatectomy.AIM To demonstrate the safety and preliminary experience of robotic radical resection of cystic and alveolar echinococcosis in posterosuperior liver segments.METHODS A retrospective analysis was conducted on the clinical data of 5 patients with a median age of 37 years(21-56 years)with cystic and alveolar echinococcosis in difficult liver lesions admitted to two centers from September to December 2019.The surgical methods included total pericystectomy,segmental hepatectomy,or hemihepatectomy.RESULTS Among the 5 patients,4 presented with cystic echinococcosis and 1 presented with alveolar echinococcosis,all of whom underwent robotic radical operation successfully without conversion to laparotomy.Total caudate lobectomy was performed in 2 cases,hepatectomy of segment Ⅶ in 1 case,total pericystectomy of segment Ⅷ in 1 case,and right hemihepatectomy in 1 case.Operation time was 225 min(175-300 min);blood loss was 100 mL(50-600 mL);and postoperative hospital stay duration was 10 d(5-19 d).The Clavien-Dindo complication grade was Ⅰ in 4 cases and Ⅱ in 1 case.No recurrence of echinococcosis was found in any patient at the 3 mo of follow-up.CONCLUSION Robotic radical surgery for cystic and selected alveolar echinococcosis in posterosuperior liver segments is safe and feasible.

腹腔镜肝后上段肿物对比肝前下段肿物切除术安全性与有效性的荟萃分析

目的:通过荟萃分析对腹腔镜肝后上段肿物与肝前下段肿物切除术的安全性及有效性进行全面评估及对比。方法:通过计算机检索PubMed、Embase、中国知网、万方数据库和维普数据库中2001年3月至2021年3月腹腔镜肝后上段肿物与肝前下段肿物切除术对比文献,纳入符合文献质量评价标准的文献,提取术中结局指标、术后短期结局指标及术后长期结局指标进行荟萃分析。结果:与肝前下段组患者相比,肝后上段组患者手术时间延长,中转开腹率增多,且差异均有统计学意义(P<0.0001)。而两组患者术中出血量、术中输血率、手术切缘距离、肝门阻断时间、术后住院时间、术后并发症发生率等差异均无统计学差异(P>0.05)。对于恶性肿瘤患者,腹腔镜切除术后患者无瘤生存期及总生存时间与肿瘤部位无关(P>0.05)。结论:腹腔镜肝后上段肿物切除术虽然难度较大,但是一种安全、有效、可行的微创手术方式,在腹腔镜技术成熟后开展可能对患者更有利。

微创肝脏后上肝段切除技术的文献回顾

微创肝脏后上段切除是富有挑战性的,其手术策略尚未规范化。笔者综述微创肝脏后上段切除的技术,包括腹腔镜和机器人下的,描述技术的细节和潜在的优缺点。通过对微创肝脏后上段切除的解剖、术前评估、手术入路、术中技术(显露、出血控制)等方面进行文献回顾和阐述,希望对微创肝脏后上段切除的规范化和个体化手术治疗策略的制订提供一些参考。