Hepatic resection under the guidance of B-mode ultrasonography
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The aim of this study was to identify the detectable threshold of knee effusion by ultrasonography while infusing saline.Forty knee osteoarthritis patients were allocated randomly to either the midline or the lateral group. Intra-articular injection of 20 ml normal saline was performed under ultrasonographic guidance with the transducer fixated at the midline longitudinal or lateral longitudinal scan in the midline and lateral groups, respectively. We obtained ultrasonography images after infusing each milliliter and measured the maximum depth of effusion.The smallest amount of infusion detected by ultrasonography was 4.37 ± 2.11 ml in the midline group and 4.13 ± 1.71 ml in the lateral group. An effusion more than 2 mm deep was observed after infusing 7.84 ± 3.85 ml and 7.38 ± 3.01 ml in the midline and lateral groups, respectively. To obtain a 4-mm depth, infusions of 11.58 ± 5.68 ml and 13.13 ± 4.88 ml were needed in the midline and lateral groups, respectively.To detect knee effusion by ultrasonography, infusion of 4.26 ml (SD, 1.92 ml) of solution is needed. We think that a depth of 2 mm is more appropriate than 4 mm as the definition of knee effusion using ultrasonography.
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In this study, we evaluate the capability of pure laparoscopic surgery for repeat hepatectomy. From June 2010 through March 2011, 15 cases of primary hepatectomy (hepatocellular carcinoma 11, liver metastasis 4) and 6 cases of re-hepatectomy patients (all cases were hepatocellular carcinoma) were underwent pure laparoscopic hepatectomy. As for the liver function in primary hepatectomy and re-hepatectomy, liver damage A/B was 8/7 and 2/4, median ICG R15 was 18 (4- 42) % and 30 (10-35) %, respectively. As for operative variables in primary hepatectomy and re-hepatectomy, the median operative duration was 265 (105-673) minutes, 296 (157-475) minutes, the median amount of bleeding was 10 (small amount-2,000) cc, 25 (small amount-140) cc, and the median post-operative hospital stay was 10 (6-17) days and 11 (6-24) days, respectively. Primary hepatectomy and re-hepatectomy represented equal clinical outcomes, although re-hepatectomy patients had lower hepatic function compared with primary hepatectomy patients.
Liver function
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Repeat hepatectomy is widely accepted as a treatment for primary or metastatic liver malignancy. However, it entails a longer operative time and is associated with additional operative risks. The goal of the present study was to evaluate the impact of previous hepatectomy on the short-term outcomes of repeat hepatectomy, especially in operative time.A retrospective review of prospectively collected data from patients who underwent primary hepatectomy (n=166) and repeat hepatectomy (n=65) in a single institution.Operative time was significantly longer for repeat hepatectomy than for primary hepatectomy (284min vs. 250min, p=0.04). There were no significant differences between the two groups with respect to intraoperative blood loss, intraoperative blood transfusion, morbidity, mortality and length of hospital stay. Multivariate analysis demonstrated that third or subsequent hepatectomy and tumor location in the caudate lobe at the repeat hepatectomy significantly prolonged operative time.Repeat hepatectomy has similar short-term outcomes to primary liver resection. However, repeat hepatectomy is a time-consuming operation, especially in patients with tumors in the caudate lobe or for those undergoing their third or subsequent hepatectomy.
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Liver Regeneration
Histology
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Objective To compare the intrahepatic recurrence of hepatocellular carcinoma after regular hepatectomy and irregular hepatectomy. Methods One hundred and twenty patients with primary liver cancer undergoing hepatectomy in our department from 2007 to 2012 were selected, which were divided into regular hepatectomy group and irregular hepatectomy group, with 60 patients in each group. General surgery condition, the liver function after six months, the recurrence rate after one year and the survival rate were compared between the two groups. Results The diameter of tumor removed, volume of liver removed, blood loss, blood transfusion, the number of hepatic resection in regular hepatectomy group were significantly higher than those in irregular hepatectomy group, P0.01. Six months after surgery, serum albumin(ALB) was significantly higher in regular hepatectomy group than irregular hepatectomy group, while TBIL, glutamic-pyruvic transaminase(ALT) and total bilirubin(DBIL) were significantly lower(P0.01). The 1-year recurrence rate in regular hepatectomy group was significantly lower than that in irregular hepatectomy group, while 1-year disease-free survival rate and 1-year overall survival rate in regular hepatectomy group were significantly higher(P0.05). Conclusion Although regular hepatectomy results in larger surgical injury, it has the advantages of larger range of resection, better postoperative recovery and lower recurrence rate, which is suitable for clinical applications.
Liver function
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Univariate analysis
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Liver function
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Objective
To study the effect of extended hepatectomy for hilar cholangiocarcinoma (HCCA) of the Bismuth-Corlette type Ⅲ and Ⅳ.
Methods
The clinical data of 73 patients with HCCA of the Bismuth-Corlette type Ⅲ and Ⅳ treated in our department from January, 2008 to June, 2016 were analyzed retrospectively. The extended hepatectomy group of patients consisted of 29 patients who underwent hepatectomy with half or more than half of the liver removed or/and combined with hepatic caudate lobectomy. The limited hepatectomy group consisted of 44 patients who underwent non-anatomical hepatectomy around the hepatic hilar region.
Results
Compared with the limited hepatectomy group, patients in the extended hepatectomy group had significantly longer operations with significantly more intraoperative blood loss. However, the complication rate was significantly lower than that of the limited hepatectomy group. There was no perioperative death in the extended hepatectomy group, while 3 perioperative deaths occurred in the limited hepatectomy group. The R0 resection rate was 93.1% (27 of 29) for the extended hepatectomy group, while it was 54.6% (24 of 44) for the limited hepatectomy group (P<0.05). The 1-, 3- and 5-year survival rates or the extended hepatectomy group were 81.4%, 51.4% and 19.3%, respectively while the corresponding rates for the limited hepatectomy group were 70.5%, 24.4% and 8.7%, respectively (P<0.05).
Conclusions
After adequate preoperative radiological assessments on tumor resectability, and the residual liver volumes, with preoperative biliary drainage to improve liver function, extended hepatectomy effectively increased R0 resection and survival rates with improved prognosis for patients with HCCA of Bismuth-Corlette type Ⅲ and Ⅳ.
Key words:
Hilar cholangiocarcinoma; Surgical therapy; Extended hepatectomy; Limited hepatectomy; Prognosis
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Objectives The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after repeat hepatectomy and to elucidate the role of multicentric occurrence in the second tumor after a first hepatectomy. Summary Background Data A repeat hepatectomy for recurrent HCC has been established as the most effective treatment modality, whenever it is possible. However, the prognostic factors for recurrent HCC after repeat hepatectomy have yet to be clarified. Methods Forty-one patients who underwent a curative repeat hepatectomy were retrospectively studied. Patient survival and disease-free survival after recurrence were univariately and multivariately analyzed using 38 clinicopathologic variables. The histologic grade of HCC at repeat hepatectomy was also compared with that at first hepatectomy. Results Patient survival after repeat hepatectomy did not differ substantially from that in 312 patients undergoing primary hepatectomy. However, the disease-free survival after repeat hepatectomy was significantly lower than that in patients with only a primary hepatectomy (p < 0.05). Multivariate analysis revealed only portal vein invasion in the first hepatectomy to be an independent and significantly poor prognostic factor. Regarding multicentric occurrence at repeat hepatectomy, only 6 of 40 patients (15%) whose specimens could be evaluated histologically were determined to be Edmondson and Steiner's Grade 1. Conclusions The only prognostic factor identified in patients with recurrent HCC after repeat hepatectomy was portal vein invasion in the first hepatectomy. Most second tumors after the first hepatectomy are considered to be caused by metastatic recurrence, not by multicentric occurrence.
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