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| 1 | Hepatocellular carcinoma: current management and recent advances显示文摘BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth most common cancer in the world, and the third most common cause of cancer-related death. Without specific treatment, the prognosis is very poor. The goal of management is 'cancer control' - a reduction in its incidence and mortality as well as an improvement in the quality of life of patients with HCC and their families. This article aims to review the current management of HCC and its recent advances. DATA SOURCES: A MEDLINE database search was performed to identify relevant article using the keyworks 'hepatocellular carcinoma', 'hepatectomy', 'liver transplantation', and 'local ablative therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Liver resection and liver transplantation remain the options that give the best chance of a cure. Recent evidence suggests that local ablative therapy may offer comparable survival results in patients with small HCC, and preserved liver function. Transarterial chemoembolization (TACE) is the most promising palliative modality for unresectable HCC, but other techniques, such as transarterial radioembolization (TARE), and local ablative therapy, have also shown comparable results. CONCLUSIONS: Early diagnosis of HCC remains a key goal in improving the prognosis of patients. During the last two decades, operative mortality and surgical outcome of liver resection and liver transplantation for HCC have improved. Progress also has been made in multi-modality therapy which can increase the chance of survival and improve the quality of life for patients with advanced HCC. | Wan-Yee Lau Eric C. H. Lai | 2008 | Hepatobiliary & Pancreatic Diseases International2008，7，3： | 100 |
| 2 | Precise hepatectomy guided by the middle hepatic vein显示文摘The middle hepatic vein(MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver 1 cm to the right or left wall of the MHV in order to avoid bleeding. However,guidance of liver transection is lost if the course of the MHV is not known. By exposing the MHV early in the phase of liver transection and following its course to the inferior vena cava,a precise liver transection plane could be obtained. Such technique has the potential of achieving adequate tumor-free resection margin,avoiding damage to intrahepatic portal pedicles,preserving venous drainage and functional liver tissue,and less postoperative infection. | Sheung-Tat Fan | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，4： | 74 |
| 3 | Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy显示文摘AIM:To evaluate the effect of low central venous pressure(LCVP)on blood loss and blood transfusion in patients undergoing hepatectomy.METHODS:Electronic databases and bibliography lists were searched for potential articles.A meta-analysis of all randomized controlled trials(RCTs)investigating LCVP in hepatectomy was performed.The following three outcomes were analyzed:blood loss,blood transfusion and duration of operation.RESULTS:Five RCTs including 283 patients were assessed.Meta-analysis showed that blood loss in the LCVP group was significantly less than that in the control group(MD=-391.95,95%CI:-559.35--224.56,P<0.00001).In addition,blood transfusion in the LCVP group was also significantly less than that in the control group(MD=-246.87,95%CI:-427.06--66.69,P=0.007).The duration of operation in the LCVP group was significantly shorter than that in the control group(MD=-18.89,95%CI:-35.18--2.59,P=0.02).Most studies found no significant difference in renal and liver function between the two groups.CONCLUSION:Controlled LCVP is a simple and effective technique to reduce blood loss and blood transfusion during liver resection,and appears to have no detrimental effects on liver and renal function. | Zhi Li Yu-Ming Sun Fei-Xiang Wu Li-Qun Yang Zhi-Jie Lu Wei-Feng Yu | 2014 | World Journal of Gastroenterology2014，20，1： | 60 |
| 4 | Laparoscopic vs open left hepatectomy for hepatolithiasis显示文摘AIM: To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis. METHODS: From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met the inclusion criteria for LLH were treated in our institute. Of the 61 patients with hepatolithiasis, 28 underwent LLH (LLH group) and 33 underwent open left hepatectomy (OLH group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, postoperative hospital stay time, stone clearance and recurrence rate were retrospectively analyzed and compared between the two groups. RESULTS: LLH was successfully performed in 28 patients. The operation time of LLH group was longer than that of OLH group (158 ± 43 min vs 132 ± 39 min, P < 0.05) and the hospital stay time of LLH group was shorter than that of OLH group (6.8 ± 2.8 d vs 10.2 ± 3.4 d, P < 0.01). No difference was found in intraoperative blood loss (180 ± 56 mL vs 184 ± 50 mL), postoperative complication rate (14.2% vs 15.2%), and stone residual rate (intermediate rate 17.9% vs 12.1% and final rate 0% vs 0%) between the twogroups. No perioperative death occurred in either group. Fifty-seven patients (93.4%) were followed up for 2-40 mo (mean 17 mo), including 27 in LLH group and 30 in OLH group. Stone recurrence occurred in 1 patient of each group. CONCLUSION: LLH for hepatolithiasis is feasible and safe in selected patients with an equal therapeutic effect to that of traditional open hepatectomy. | Tu, Jin-Fu Jiang, Fei-Zhao Zhu, Heng-Liang Hu, Ru-Ying Zhang, Wei-Jian Zhou, Zhen-Xu | 2010 | World Journal of Gastroenterology2010，16，22： | 30 |
| 5 | Therapy and prognostic features of primary clear cell carcinoma of the liver显示文摘AIM:To clarify the therapeutic strategies and prognosis factors of primary clear cell carcinoma of the liver(PCCCL) . METHODS:The clinical pathological data of 64 patients with PCCCL treated with hepatectomy in our hospital from January 2000 to January 2006 were analyzed retrospectively.The patients were divided into two groups to make treatment analysis:curative resection only(n=40) ;and curative resection and postoperative chemotherapy with calcium folinate and tegafur(n= 24) .Meanwhile,the PCCCL patients were subdivided into two subgroups on the basis of the proportion of clear cells in the tumor for pathological analysis.There were 36 cases in subgroup A for which the proportion of clear cells was more than 70%,and 28 cases in subgroup B for which the proportion was less or equal to 70%,comparing analysis of median survival time of the counterpart groups.Univariate and multivariate analyses were performed to examine factors that affect-ed clinical prognosis,recurrence and metastasis. RESULTS:Median survival period of the curative surgery group was 38 mo,while the counterpart was 41 mo.Median survival period for group A was 41 mo,while group B was 19 mo.The Kaplan-Meier method showed that capsule formation,preoperative liver function,hepatitis C virus infection,large vascular invasion and multiple tumor occurrences were related to disease-free survival.Cox regression analysis showed that the clear cell ratio,capsule formation,preoperative liver function and large vascular invasion were independent risk factors for overall survival. CONCLUSION:Postoperative chemotherapy has no obvious effect on survival of patients with PCCCL. Clear cell ratio,capsule formation,preoperative liver function,and vascular invasion were independent risk factors for prognosis. | Ji, Sheng-Pu Li, Qiang Dong, Hui | 2010 | World Journal of Gastroenterology2010，16，6： | 28 |
| 6 | Methods of vascular control technique during liver resection:a comprehensive review显示文摘BACKGROUND:Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection.Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection.This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection.DATA SOURCES:The relevant manuscripts were identified by searching MEDLINE,and PubMed for articles published between January 1980 and April 2010 using the keywords ' vascular control','vascular clamping','vascular exclusion' and 'hepatectomy'.Additional papers were identified by a manual search of the references from the key articles.RESULTS:One randomized controlled trial(RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone,respectively.Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver.One showed Pringle maneuver to be beneficial,while the other failed to show any benefit.One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver.Four RCTs evaluated the use of hemihepatic vascular occlusion.One RCT showed it had significantly less blood loss than Pringle maneuver,while the other 3 showed no significant difference.Only 1 RCT showed it had significantly less liver ischemic injury.No RCT had been carried out to assess segmental vascular occlusion.Two RCTs compared the outcomes of total hepatic vascular exclusion(THVE) and Pringle maneuver.One RCT showed THVE resulted in similar blood loss,but a higher postoperative complication.The other RCT showed less blood loss using THVE but the postoperative complication rate was similar.Both studies showed similar degree of liver ischemic injury.Only one RCT showed that selective hepatic vascular exclusion(SHVE) had less blood loss and liver ischemic injury than Pringle maneuver.CONCLUSION:Due to the great variations in these studies,it is difficult to draw a definitive conclusion on the best technique of hepatic vascular control. | Wan-Yee Lau Eric C.H.Lai Stephanie H.Y.Lau | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，5： | 27 |
| 7 | Surgical strategy for bile duct cancer:Advances and current limitations显示文摘The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer.Radical resection with a microscopically negative margin(R0)is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections.Complete resection of the tumor is the surgeon’s ultimate aim,and several advances in the surgical treatment for bile duct cancer have been made within the last two decades.Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer,in terms of both longitudinal and vertical tumor invasion.Many meticulous operative procedures have been established,especially extended hepatectomy for hilar cholangiocarcinoma,to achieve a negative resection margin,which is the only prognostic factor under the control of the surgeon.A complete caudate lobectomy and resection of the inferior part of Couinaud’s segmentⅣcoupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma,and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer.Limited resection for middle bile duct cancer is indicated for only strictly selected cases.Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients,especially jaundiced patients anticipating major hepatectomy.Liver transplantation seems ideal for complete resection of bile duct cancer,but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment.Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence,but no definite regimen has been established to date.Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy. | Nobuhisa Akamatsu Yasuhiko Sugawara Daijo Hashimoto | 2011 | World Journal of Clinical Oncology2011，2，2： | 27 |
| 8 | Hepatocellular carcinoma:A comprehensive review显示文摘Hepatocellular carcinoma(HCC) is rapidly becoming one of the most prevalent cancers worldwide. With a rising rate, it is a prominent source of mortality. Patients with advanced fibrosis, predominantly cirrhosis and hepatitis B are predisposed to developing HCC. Individuals withchronic hepatitis B and C infections are most commonly afflicted. Different therapeutic options, including liver resection, transplantation, systemic and local therapy, must be tailored to each patient. Liver transplantation offers leading results to achieve a cure. The Milan criteria is acknowledged as the model to classify the individuals that meet requirements to undergo transplantation. Mean survival remains suboptimal because of long waiting times and limited donor organ resources. Recent debates involve expansion of these criteria to create options for patients with HCC to increase overall survival. | Lisa P Waller Vrushak Deshpande Nikolaos Pyrsopoulos | 2015 | World Journal of Hepatology2015，7，26： | 26 |
| 9 | Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy显示文摘AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups:a ropivacaine group(wound infiltration with ropivacaine solution)and a control group(infiltration with isotonic saline solution).A visual analog scale(VAS)at rest and on movement was used to measure postoperative pain for the first 48 h after surgery.Mean arterial pressure(MAP),heart rate(HR),time to bowel recovery,length of hospitalization after surgery,cumulative sufentanil consumption,and incidence of nausea and vomiting were compared between the two groups.Surgical stress hormones(epinephrine,norepinephrine,and cortisol)were detected using enzyme-linked immunosorbent assay,and the results were compared. RESULTS VAS scores both at rest and on movement at 24 h and48 h were similar between the two groups.Significantly lower VAS scores were detected at 0,6,and 12 h in the ropivacaine group compared with the control group(P<0.05 for all).MAP was significantly lower at 6,12,and 24 h(P<0.05 for all);HR was significantly lower at 0,6,12,and 24 h(P<0.05 for all);time to bowel recovery and length of hospitalization after surgery(P<0.05 for both)were significantly shortened;and cumulative sufentanil consumption was significantly lower at 6,12,24,and 36 h(P<0.05 for all)in the ropivacaine group than in the control group,although the incidence of nausea and vomiting showed no significant difference between the two groups.The levels of epinephrine,norepinephrine,and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h(P<0.01 for all). CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief,reduce surgical stress response,and accelerate postoperative recovery. | Jing-Xian Sun Ke-Yun Bai Yan-Feng Liu Gang Du Zhi-Hao Fu Hao Zhang Jin-Huan Yang Ben Wang Xiu-Yu Wang Bin Jin | 2017 | World Journal of Gastroenterology2017，23，36： | 25 |
| 10 | The current role of neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for hepatocellular carcinoma:a systematic review显示文摘BACKGROUND:Following curative treatment for hepato-cellular carcinoma(HCC),50%-90% of postoperative death is due to recurrent disease.Intra-hepatic recurrence is frequently the only site of recurrence.Thus,any neoadjuvant or adjuvant therapy,which can decrease or delay the incidence of intra-hepatic recurrence,or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant,will improve the results of liver resection.This article systematically reviewed the current evidence of neoadjuvant,adjuvant, and chemoprevention in partial hepatectomy of HCC. DATA SOURCES:Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma','hepatectomy','adjuvant therapy','neoadjuvant therapy',and'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS:Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy± embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with 131 I-lipiodol and adjuvant systemic interferon showed promising results.However,there were only a limited number of such studies.CONCLUSIONS:Further randomized controlled studies need to be carried out.Currently,there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC. | Wan-Yee Lau Eric C.H.Lai Stephanie H.Y.Lau | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，2： | 24 |
| 11 | Management of post-hepatectomy complications显示文摘Hepatic resection had an impressive growth over time.It has been widely performed for the treatment of various liver diseases,such as malignant tumors,benign tumors,calculi in the intrahepatic ducts,hydatid disease,and abscesses.Management of hepatic resection is challenging.Despite technical advances and high experience of liver resection of specialized centers,it is still burdened by relatively high rates of postoperative morbidity and mortality.Especially,complex resections are being increasingly performed in high risk and older patient population.Operation on the liver is especially challenging because of its unique anatomic architecture and because of its vital functions.Common posthepatectomy complications include venous catheterrelated infection,pleural effusion,incisional infection,pulmonary atelectasis or infection,ascites,subphrenic infection,urinary tract infection,intraperitoneal hemorrhage,gastrointestinal tract bleeding,biliary tract hemorrhage,coagulation disorders,bile leakage,and liver failure.These problems are closely related to sur-gical manipulations,anesthesia,preoperative evaluation and preparation,and postoperative observation and management.The safety profile of hepatectomy probably can be improved if the surgeons and medical staff involved have comprehensive knowledge of the expected complications and expertise in their management.This review article focuses on the major postoperative issues after hepatic resection and presents the current management. | Shan Jin Quan Fu Gerile Wuyun Tu Wuyun | 2013 | World Journal of Gastroenterology2013，19，44： | 24 |
| 12 | A new scoring system for assessment of liver function after successful hepatectomy in patients with hepatocellular carcinoma显示文摘BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient's hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring system as a guide to determine a safe limit for liver resection and avoid liver dysfunction after hepatectomy.METHODS:Eighty-six patients with hepatocellular carcinoma who had undergone hepatectomy in West China Hospital from March 2007 to June 2010 were reviewed.The patients were classified according to the levels of total bilirubin after hepatectomy and the parameters in the perioperative period were compared.Receiver operating characteristic (ROC) analysis was made to assess the liver function compensatory (LFC) value to predict liver dysfunction of the patients after hepatectomy.LFC value is defined as the preoperative KICG value×22.487+standard remnant liver volume (SRLV)×0.020.RESULTS:Patients were classified into group Ⅰ (normal group,n=69) and group Ⅱ (with total bilirubin >85.5 μmol/L for 7 days after hepatectomy,n=17) based on the levels of total bilirubin after hepatectomy.Group II was further divided into two subgroups:recovered subgroup (n=14) and fatal subgroup (n=3).There were no significant differences in preoperative data or intraoperative findings except the indocyanine green test parameters (KICG and ICG R15) and SRLV.ROC analysis showed that the sensitivity and specificity of an LFC value ≤13.01 were 94.1% and 82.6% respectively for predicting liver dysfunction of the patients after hepatectomy.CONCLUSIONS:The LFC value appears to be a good predictor of postoperative liver dysfunction in patients who undergo hepatectomy for HCC.An expected LFC value of 13.01 seems to be a safe limit for liver resection. | Zheng-Gui Du,Bo Li,Yong-Gang Wei,Jie Yin,Xi Feng and Xi Chen Department of Liver and Vascular Surgery,West China Hospital,Sichuan University,Chengdu 610041,China | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，3： | 23 |
| 13 | Clinical research advances in primary liver cancer显示文摘Primarylivercancer(PLC)isoneofthemostcommoncancersinChina.Accordingtothestatisticsofourcountry,primarylivercancerclaims2040l... | WU Meng Chao | 1998 | World Journal of Gastroenterology1998，4，6： | 23 |
| 14 | Laparoscopic liver resection:Experience based guidelines显示文摘Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. | fabricio ferreira coelho jaime arthur pirola kruger gilton marques fonseca raphael leonardo cunha araújo vagner birk jeismann marcos vinícius perini renato micelli lupinacci ivan cecconello paulo herman | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 22 |
| 15 | Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation显示文摘AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions:viewing 3D models from arbitrary directions,changing the colors and opacities of the models,deforming the models based on user interaction,and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013,99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013,11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim wasused. Furthermore,medical students and surgical residents were asked to complete questionnaires regarding the new software.RESULTS:There were no obvious discrepancies(i.e.,the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min(range,110 to 846) in the VINCENT group and 397 min(range,232 to 497) in the Liversim group(P = 0.30). The median amount of intraoperative bleeding was 510 m L(range,18 to 5120) in the VINCENT group and 470 m L(range,130 to 1600) in the Liversim group(P = 0.44). The median postoperative stay was 12 d(range,6 to 100) in the VINCENT group and 13 d(range,9 to 21) in the Liversim group(P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that the Liversim image was almost the same as the actual hepatectomy.CONCLUSION:Virtual hepatectomy with real-time deformation of the liver using Liversim is useful for the safe performance of hepatectomies and for surgical education. | Yukio Oshiro Hiroaki Yano Jun Mitani Sangtae Kim Jaejeong Kim Kiyoshi Fukunaga Nobuhiro Ohkohchi | 2015 | World Journal of Gastroenterology2015，21，34： | 23 |
| 16 | Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease显示文摘Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma(HCC) patients with chronic liver diseases,are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field.Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures.These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. | Zenichi Morise Norihiko Kawabe Jin Kawase Hirokazu Tomishige Hidetoshi Nagata Hisanori Ohshima Satoshi Arakawa Rie Yoshida Masashi Isetani | 2013 | World Journal of Hepatology2013，5，9： | 21 |
| 17 | Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma:A pilot study显示文摘AIM: To describe a three-dimensional model(3DM) to accurately reconstruct anatomic relationships of centrally located hepatocellular carcinomas(HCCs).METHODS: From March 2013 to July 2014, reconstructions and visual simulations of centrally located HCCs were performed in 39 patients using a 3D subject-based computed tomography(CT) model with customdeveloped software. CT images were used for the 3D reconstruction of Couinaud's pedicles and hepatic veins, and the calculation of corresponding tumor territories and hepatic segments was performed using Yorktal DMIT software. The respective volume, surgical margin, and simulated virtual resection of tumors were also estimated by this model preoperatively. All patients were treated surgically and the results were retrospectively assessed. Clinical characteristics, imaging data, procedure variables, pathologic features, and postoperative data were recorded and compared to determine the reliability of the model.RESULTS: 3D reconstruction allowed stereoscopic identification of the spatial relationships between physiologic and pathologic structures, and offered quantifiable liver resection proposals based on individualized liver anatomy. The predicted values were consistent with the actual values for tumor mass volume(82.4 ± 109.1 m L vs 84.1 ± 108.9 m L, P = 0.910), surgical margin(10.1 ± 6.2 mm vs 9.1 ± 5.9 mm, P = 0.488), and maximum tumor diameter(4.61 ± 2.16 cm vs 4.53 ± 2.14 cm, P = 0.871). In addition,the number and extent of portal venous ramifications, as well as their relation to hepatic veins, were visualized. Preoperative planning based on simulated resection facilitated complete resection of large tumors located in the confluence of major vessels. And most of the predicted data were correlated with intraoperative findings.CONCLUSION: This 3DM provides quantitative morphometry of tumor masses and a stereo-relationship with adjacent structures, thus providing a promising technique for the management of centrally located HCCs. | Fei Tian Jian-Xiong Wu Wei-Qi Rong Li-Ming Wang Fan Wu Wei-Bo Yu Song-Lin An Fa-Qiang Liu Li Feng Chao Bi Yun-He Liu | 2015 | World Journal of Gastroenterology2015，21，15： | 21 |
| 18 | Risk factors associated with early and late recurrence after curative resection of hepatocellular carcinoma: a single institution's experience with 398 consecutive patients显示文摘BACKGROUND: Surgical resection is an important curative treatment for hepatocellular carcinoma (HCC); however, some patients experience an unexpected recurrence even after hepatectomy. The present study aimed to investigate risk factors and predictive criteria for early and late recurrence of HCC after resection.METHODS: A retrospective analysis of 398 Chinese patients who received curative resection for HCC was conducted. Patients were divided into three groups: without recurrence, early recurrence and late recurrence. Prognostic factors and predictive criteria for early and late recurrence were statistically analyzed. RESULTS: The cumulative recurrence-free survival rates at1, 2, 3, 4, and 5 years were 75.5%, 58.2%, 54.1%, 40.5%, and28.7%, respectively. The distribution of the time to recurrence suggested that recurrence could be divided into early phase(before 2 years; n=164) and late phase (after 2 years; n=83)Cox's multivariate proportional hazard model analysis revealed that multiplicity of tumors (P=0.004) and venous infiltration(P=0.002) were independent risk factors associated with early recurrence. In contrast, indocyanine green retention rate at 15minutes (P=0.007), serum albumin level (P=0.045), and HBeAg status ( =0.028) proved to be significant independent adverse prognostic factors for late recurrence. Patients with at least 1of the 2 early recurrence risk factors (multiplicity of tumors ≥2and venous infiltration) or with 2 or more late recurrence risk factors are often susceptible to recurrence (P=1.36e-4 and 1.0e-6respectively).CONCLUSIONS: Early and late recurrences correlate with different risk factors and predictive criteria. Early recurrence primarily results from intrahepatic metastases, while late recurrence may be multicentric in origin. | Zheng-Gui Du Yong-Gang Wei Ke-Fei Chen Bo Li | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，2： | 20 |
| 19 | Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach显示文摘Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver. | Zenichi Morise | 2016 | World Journal of Gastroenterology2016，22，47： | 20 |
| 20 | Liver resection for cancer显示文摘HISTORY OF HEPATIC RESECTIONThe earliest hepatic surgery was almost exclusively performed for trauma with records from as for tumor were those of Langenbuch in 1888 [3] , Tiffany in 1890 [4],and Lucke in 1891[5].By1899,76 cases of liver resection had been reported with a mortality rate of 14.9% [6], a remarkably low figure for operations of this magnitude,all performed at the end of the 19th century. | RWParks OJGarden | 2001 | World Journal of Gastroenterology2001，7，6： | 20 |
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