Chinese guidelines for minimally invasive donor hepatectomy in living donor liver transplantation Minimally invasive surgeries are increasingly central to modern medicine, particularly in liver transplantation. These techniques, which offer reduced trauma, precise operations, minimal bleeding, and swift recovery, are, however, unevenly adopted across China. Only a limited number of centers routinely perform minimally invasive donor hepatectomies, indicating a significant imbalance in the development and application of these advanced procedures. Additionally, there lacks a set of standardized guidelines that are tailored to meet China's unique healthcare challenges and conditions. In August 2023, the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant
Impact of Non-Hepatectomy Opioid Reduction Efforts on Post-Hepatectomy Opioid Prescriptions: Analysis of 2,005 Patients. Pathway-driven, post-pancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study's aim was to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy. This is a retrospective cohort study utilizing data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (09/2016-02/2024). Cohorts were based on 5 distinct eras (E) of opioid-related protocol updates (E1/pre-intervention historical baseline: 09/2016-03/2017, E2/introduction of 5x-multiplier
Feasibility of Pure Laparoscopic Donor Right Hepatectomy Compared to Open Donor Right Hepatectomy: A Large Single-Center Cohort Study. This study aimed to compare morbidity of living donors and recipients after pure laparoscopic donor right hepatectomy (PLDRH) and open donor right hepatectomy (ODRH). Donor and recipient morbidity have not been sufficiently reported in large-scale comparisons ), and biliary complications (P=0.001). Separated multiple bile ducts were common significant recipient risk factor for bile leakage (P=0.007) and biliary stricture (P=0.022). PLDRH could become the standard for donor right hepatectomy with careful consideration of portal and biliary variations for donor and recipient safety.
Comparing the accuracy of prediction models to detect clinically relevant post-hepatectomy liver failure early after major hepatectomy. Arterial lactate measurements were recently suggested as an early predictor of clinically relevant post-hepatectomy liver failure (PHLF). This needed to be evaluated in the subgroup of major hepatectomies only. This observational cohort study included consecutive elective major hepatectomies at Karolinska University Hospital from 2010 to 2018. Clinical risk factors for PHLF, perioperative arterial lactate measurements and routine lab values were included in uni- and multivariable regression analysis. Receiver operating characteristics and risk cut-offs were calculated. In total, 649 patients constituted the study cohort, of which 92 developed PHLF grade
Hepatectomy with Hepatic Vein Resection and Reconstruction Under Total Vascular Exclusion and Venous Drainage via a Venovenous Bypass: An Additional Approach for Complex Hepatectomies. Total vascular exclusion (TVE) with liver hypothermic perfusion under venovenous bypass (VVB) is usually needed to perform hepatectomy with Inferior vena cava and hepatic veins resection-reconstruction . An alternative technique is represented by liver resection under intermittent pedicular clamping, IVC total clamping and VVB, without cold perfusion and liver outflow drainage through the VVB. PATIENTS AND METHODS: The patient is a 60-year-old woman with past medical history of right hepatectomy for leiomyosarcoma 14 years previously. She presented with a single liver recurrence on the left liver remnant
Treatment-sequencing before and after index hepatectomy with either synchronous or metachronous colorectal liver metastasis: Comparison of recurrence risk, repeat hepatectomy and overall survival in a population-derived cohort. Treatment of colorectal cancer liver metastasis (CRLM) includes several options with impact on the patient journey and may depend on presentation and patient characteristics. The aim of the study was to investigate how treatment sequencing in index hepatectomy for synchronous or metachronous CRLM may potentially impact treatment pathways and oncological outcomes. An observational cohort study (ACROBATICC; NCT0176813) of patients having surgery for CRLM. Patient and tumour characteristics, treatment and recurrence patterns were recorded. Recurrence-free (RFS
Feasibility, safety, and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy for small hepatocellular carcinoma: A retrospective study. Advancements in diagnostic modalities, such as enhanced magnetic resonance imaging, provide increased opportunities for identifying small hepatocellular carcinoma that is undetectable on preoperative ultrasonography. Whether it is acceptable to leave these lesions untreated is uncertain. This study aimed to evaluate the safety and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy using new navigation systems. This study was conducted between July 2019 and January 2023. We retrospectively studied the clinicopathological features and prognoses of patients with small hepatocellular carcinoma who underwent curative
Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies. To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)" and 90-day mortality. PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF. Adults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day
Left-sided Hepatectomy Leads to Less Postoperative Liver Failure and Comparable Overall Survival to Right-sided Hepatectomy in Type II or IV Perihilar Cholangiocarcinoma. Right-side hepatectomy (RH) is used in oncological resection for perihilar cholangiocarcinoma (PHC); however, the decision between performing left-side hepatectomy (LH) or RH is still controversial. We compared surgical and oncologic outcomes of LH and RH in PHC type II or IV where either hepatectomy was expected to have a negative margin. From 2001 to 2020, 99 patients underwent major liver resection for type II or IV PHC. Patients with unilateral vascular invasion, unilateral tumor growth, and atrophy of unilateral liver were excluded. Preoperative characteristics, perioperative, and long-term outcomes were compared
Mini-incision Right Hepatectomy for Living Donor Hepatectomy. The application of a minimally invasive technique to graft procurement in living donor liver transplantation has minimized skin incisions and led to early recovery in donor hepatectomy while ensuring donor safety. This study aimed to evaluate the safety and feasibility of mini-incision living donor right hepatectomy compared with conventional open surgery. The study population consisted of 448 consecutive living donors who underwent living donor right hepatectomy performed by a single surgeon between January 2015 and December 2019. According to the incision type, the donors were divided into 2 groups: a right subcostal mini-incision group (M group: n = 187) and a conventional J-shaped incision group (C group: n = 261). A propensity
Albumin-Bilirubin Score at Post-Hepatectomy Hepatocellular Carcinoma Recurrence: Impact on Survival and Association with Post-Hepatectomy Liver Failure. Our objective was to investigate the impact of albumin-bilirubin (ALBI) score at the time of post-hepatectomy hepatocellular carcinoma (HCC) recurrence on survival after recurrence (SAR). We further explored the perioperative factors associated with the ALBI score at recurrence. Patients who underwent primary hepatectomy for HCC between 2007 and 2018 and developed recurrence were included in the study. Cox regression models were used to assess the association between the ALBI score at recurrence and SAR. Linear regression models were used to explore factors associated with ALBI score at recurrence. Of the 233 patients analyzed, 158 developed
Volumetric Remodeling of the Left Liver After Right Hepatectomy: Analysis of Factors Predicting Degree of Hypertrophy and Post-hepatectomy Liver Failure. This study investigated the volumetric remodeling of the left liver after right hepatectomy looking for factors predicting the degree of hypertrophy and severe post-hepatectomy liver failure (PHLF). In a cohort of 121 right hepatectomies, we performed CT volumetrics study of the future left liver remnant (FLR) preoperatively and postoperatively. Factors influencing FLR degree of hypertrophy and severe PHLF were identified by multivariate analysis. After right hepatectomy, the mean degree of hypertrophy and kinetic growth rate of the left liver remnant were 25% and 3%/day respectively. The mean liver volume recovery rate was 77%. Liver
Development and Validation of Prediction Models and Risk Calculators for Post-Hepatectomy Liver Failure and Postoperative Complications using a Diverse International Cohort of Major Hepatectomies. The study aim was to develop and validate models to predict clinically significant post-hepatectomy liver failure (PHLF) and serious complications (a Comprehensive Complication Index® [CCI®]>40) using preoperative and intraoperative variables. PHLF is a serious complication after major hepatectomy but does not comprehensively capture a patient's postoperative course. Adding the CCI® as an additional metric can account for complications unrelated to liver function. The cohort included adult patients who underwent major hepatectomies at twelve international centers (2010-2020). After splitting the data
Recurrence-free survival after hepatectomy using propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: a randomised controlled study. While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma. Adult patients scheduled for elective hepatectomy for hepatocellular carcinoma were assigned randomly (1:1) to either propofol-based total intravenous anaesthesia or sevoflurane-based inhalational anaesthesia. For recurrence-free survival
Detachment of the Intersegmental Plane in Robotic Left Hepatectomy Using Indocyanine Green Fluorescent Imaging (with Video). Anatomical liver resection has been altered by a deeper understanding of the internal structure of the liver, highlighting the importance of the intersegmental plane, a region lacking Glissonean branches. These insights have enabled a novel surgical technique focused on the precise detachment of the intersegmental plane, supported by indocyanine green (ICG) fluorescent imaging and robotic platforms, enhancing the precision and safety of liver resection. This study involved four patients who underwent robotic left hepatectomy using the Da Vinci Xi system. The extrahepatic Glissonean approach was applied, followed by ICG-guided delineation of the intersegmental plane
Development of a LASSO machine learning algorithm-based model for postoperative delirium prediction in hepatectomy patients. The objective of this study was to develop and validate a clinically applicable nomogram for predicting the risk of delirium following hepatectomy. We applied the LASSO regression model to identify the independent risk factors associated with POD. Subsequently, we utilized ) for the model. The DCA curve representing the net benefit demonstrated the strong clinical validity of the model in predicting postoperative delirium. Our results demonstrated that LASSO-based regression effectively constructed a nomogram model for predicting post-hepatectomy delirium.
Robotic Anatomical Segment VIII Resection for Hepatocellular Carcinoma Using the Scissor Hepatectomy Technique. Robotic hepatectomy has been increasingly adopted for the treatment of hepatocellular carcinoma (HCC). However, the ideal technique of parenchymal transection in robotic hepatectomy has been a matter of ongoing debate in literature. In this video, we demonstrate the technique of robotic anatomical segment VIII resection using the scissor hepatectomy technique for parenchymal transection on a 75-year-old male patient with a solitary HCC lesion. The patient had viral hepatitis (chronic hepatitis B infection) with a compensated liver cirrhosis and a new solitary 40 mm lesion on cross-sectional imaging. The AFP-negative lesion was biopsied, and the diagnosis of HCC was confirmed
Posterior Hepatectomy and Inferior Vena Cava Graft Reconstruction for En Bloc Resection of a Hepatocellular Carcinoma: A Tribute to Couinaud's Liver Anatomy Description. Hepatocellular carcinoma (HCC) associated with major vasculature tumor extension is considered an advanced stage of disease to which palliative radiotherapy or chemotherapy is proposed. Surgical resection associated surgery and the tumor was initially considered unresectable. Transarterial chemoembolization was judged ineffective due to the size and location of the tumor. Initial treatment included 6 months of atezolizumab-bevacizumab, permitting tumor volume stability and enabling surgical resection. The procedure included an en bloc posterior hepatectomy (H1267) with IVC resection and polytetrafluoroethylene
CT-based detection of clinically significant portal hypertension predicts post-hepatectomy outcomes in hepatocellular carcinoma. While the CT-based method of detecting clinically significant portal hypertension (CSPH) emerged as a noninvasive alternative for evaluating CSPH, its predictive ability for post-hepatectomy outcomes is unknown. Therefore, this study aimed to evaluate the impact of CT -based CSPH on outcomes following hepatectomy for hepatocellular carcinoma (HCC). This retrospective single-center study included patients with advanced chronic liver disease (ACLD) who underwent hepatectomy for very early or early-stage HCC between January 2017 and December 2018. CSPH was assessed using CT-based criteria, which included splenomegaly determined by deep learning-based spleen volume
Anatomical Insights into Rouviere's Sulcus Through the Glissonean Approach in Minimally Invasive Right-Sided Hepatectomy. Understanding the liver anatomy, particularly the Rouviere sulcus (RS), is crucial for safely performing cholecystectomy and hepatectomy. As surgical interest in right-sided hepatectomies using the Glissonean pedicle approach has increased, a thorough understanding of the RS anatomy is becoming increasingly important. This study aimed to investigate the presence and anatomical contents of the RS during right-sided hepatectomy and to develop a preoperative assessment method to improve surgical safety and precision. Patients who underwent laparoscopic or robotic right-sided hepatectomy with RS dissection were included in the study. The RS was categorized into open and closed