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Sunggyu Lee - One of the best experts on this subject based on the ideXlab platform.
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technical refinement of prosthetic vascular graft anastomosis to recipient inferior vena cava for secure middle Hepatic Vein reconstruction in living donor liver transplantation
Annals of Hepato-Biliary-Pancreatic Surgery, 2020Co-Authors: Iji Jeong, Shin Hwang, Giwon Song, Donghwan Jung, Kihun Kim, Deokbog Moon, Chulsoo Ahn, Gilchun Park, Youngin Yoon, Sunggyu LeeAbstract:Backgrounds/Aims Hemashield vascular grafts has been used for middle Hepatic Vein (MHV) reconstruction during living donor liver transplantation (LDLT). We occasionally encounter outflow disturbance of MHV conduit at the anastomotic stump of the middle-left Hepatic Vein (MLHV) trunk. To mitigate the disturbance, we carried out a series of studies regarding hemodynamics-compliant MHV reconstruction. Methods This study comprised of three parts: Part 1: Determining the causes of outflow disturbance; Part 2: Computational simulative analysis; and, Part 3: Clinical application of our refined technique. The types of Hemashield conduit-MLHV stump reconstruction were end-to-end anastomosis (type 1), side-to-end anastomosis (type 2), and oblique cutting of the conduit end and patch plasty (type 3). Results In Part 1 study, the reconstruction types were type 1 in 23, type 2 in 25, and type 3 in 2. Significant anastomotic stenosis was identified in 7 (30.4%) in type 1, 6 (24.0%) in type 2, and none (0%) in type 3. The size of MLHV stump was the most important factor for anastomotic stenosis. Through Part 2 study, technical knacks were developed as follows: the conduit end was cut in a dumb-bell shape and a vessel patch attached; and then sutured bidirectionally from the 9 o'clock direction. In Part 3 study, these knacks were applied to 5 patients and none of them experienced noticeable anastomotic stenosis. Conclusions Our refined technique to perform conduit-MLHV stump anastomosis appears to reduce the risk of anastomotic outflow disturbance for relatively small MLHV stump.
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preoperative sequential portal and Hepatic Vein embolization in patients with hepatobiliary malignancy
World Journal of Surgery, 2015Co-Authors: Shin Hwang, Dongil Kwon, Giwon Song, Donghwan Jung, Myunghwan Kim, Sungkoo Lee, Sunggyu LeeAbstract:Background Preoperative portal Vein embolization (PVE) induces shrinkage of the embolized lobe and compensatory regeneration in the non-embolized lobe, but does not always induce sufficient regeneration of the future remnant liver (FRL). We previously developed preoperative sequential PVE–Hepatic Vein embolization (HVE), and here we present our experience of treating 42 patients with sequential PVE–HVE.
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sequential preoperative ipsilateral Hepatic Vein embolization after portal Vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy
Annals of Surgery, 2009Co-Authors: Shin Hwang, Myunghwan Kim, Sungkoo Lee, Sunggyu Lee, Kyu Bo Sung, Bum Soo Kim, Heanam HongAbstract:Objective To assess the effect of ipsilateral Hepatic Vein embolization (HVE) performed after portal Vein embolization (PVE) on liver regeneration. Summary background data PVE induces shrinkage of the embolized lobe and compensatory enlargement of the non-embolized lobe, but it does not always induce sufficient liver regeneration. There was no effective method to accelerate liver regeneration in addition to PVE yet. Methods During a 1-year study period, preoperative HVE were performed on 12 patients who had shown limited liver regeneration after PVE awaiting right hepatectomy. The right Hepatic Vein was embolized with multiple coils after insertion of vena cava filters or vascular plugs. Results No HVE procedure-related complications occurred, but embolization of the wrong Hepatic Vein trunk occurred in 1 patient. The increase in blood liver enzymes after HVE was comparable with that after PVE alone. In 9 patients who underwent hepatectomy, the proportions of future liver remnant volume to total liver volume were 34.8% +/- 1.5% before PVE, 39.7% +/- 0.6% 1 to 2 weeks after PVE, 44.2% +/- 1.1% 2 weeks after HVE, and 64.5% +/- 6.2% 1 week after right hepatectomy. Cirrhotic livers showed lower regeneration rates following HVE after PVE and 1 patient underwent hepatectomy 17 months after HVE. Immunohistochemistry showed that apoptosis occurred more in the liver area affected by both PVE and HVE than in that affected by PVE alone. Conclusions Preoperative sequential application of PVE and HVE seems to be safe and effective in facilitating contralateral liver regeneration by inducing more severe liver damage than PVE alone.
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techniques of reconstruction of Hepatic Veins in living donor liver transplantation especially for right Hepatic Vein and major short Hepatic Veins of right lobe graft
Journal of Hepato-biliary-pancreatic Surgery, 2006Co-Authors: Sunggyu LeeAbstract:Living-donor liver transplantation (LDLT) is now widely accepted as a therapeutic option for adult patients with acute and chronic end-stage liver disease. In the early period, the left lobe was the major liver graft used in adult LDLT to ensure donor safety, especially in Eastern countries. However, the frequent extremes of graft-size insufficiency in left-lobe LDLT represented a greater risk of small-for-size graft syndrome in the recipient, which has focused attention on transplantation of the right lobe from a living donor. The major concern of right-lobe LDLT has focused on its safety for the donor and the necessity for including the middle Hepatic Vein (MHV) in the graft to avoid congestion of the right anterior segment. The MHV carries out important venous drainage for the right anterior segment and is essential for perfect graft function. The decision of whether to take the MHV with the liver graft (extended right lobe graft) or whether to retain it in the donor, with reconstruction of the MHV tributaries in the liver graft (modified right lobe graft) has been extensively discussed in numerous studies. However, adequate right Hepatic Vein and major short Hepatic Vein (middle and inferior right Hepatic Vein [RHV]) drainage of the liver graft is perhaps equally important as MHV outflow drainage for the integrity of right-lobe graft function. Herein, the author describes various techniques of venoplasty of the right Hepatic Vein (RHV) and the major short Hepatic Veins to obviate venous outflow obstruction in these Veins.
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intraoperative assessment of Hepatic venous congestion with direct clamping of the Hepatic Vein trunk for living donor liver transplantation
Transplantation proceedings, 2004Co-Authors: Sanghyun Hwang, Sunggyu Lee, Kihun Kim, Kwangmin Park, Youngsang Lee, C S Ahn, D B Moon, Sunghoon ChoAbstract:We devised a Hepatic Vein clamping method to assess the amount of Hepatic venous congestion (HVC) before liver transection. From February 2003 to May 2003, this method was applied to 5 of 58 living donor livers especially to assess donor safety. The left portal Vein and proper Hepatic artery as well as the middle Hepatic Vein (MHV)-left Hepatic Vein (LHV) trunk were clamped simultaneously to assess the HVC in the remnant right lobe before performing extended left lobectomy. As three donors demonstrated the extent of the HVC equivalent to about 40% of the right lobe volume (RLV), their operations proceeded according to the preoperative plan. The territory of HVC after liver transection was the same as that observed with direct clamping of the Hepatic Vein. However, one donor showed massive HVC more than 50% of RLV and the operative plan was adjusted to harvest only the left lobe without the MHV trunk for donor safety. To assess the HVC in the remnant left lobe, the isolated LHV trunk was occluded after clamping the donor's proper Hepatic artery. The whole left lobe except for a small area at the anterior portion of the medial segment became discolored on LHV clamping: the opposite demarcation appeared on MHV clamping. The amount of HVC was so small that we harvested the right lobe with the MHV trunk. All donors and recipients recovered uneventfully. We believe that this direct clamping method makes the assessment of HVC feasible before parenchymal transection of a donor liver.
Masatoshi Makuuchi - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of hepatocellular carcinoma associated with Hepatic Vein tumor thrombosis
Journal of Hepatology, 2014Co-Authors: Takashi Kokudo, Masatoshi Makuuchi, Yasuhiko Sugawara, Kiyoshi Hasegawa, Satoshi Yamamoto, Junichi Shindoh, Nobuyuki Takemura, Taku Aoki, Yoshihiro Sakamoto, Norihiro KokudoAbstract:Background & Aims Presence of Hepatic Vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT. Methods Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analysed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral Hepatic Vein, including microscopic invasion (pHVTT), tumor thrombosis in a major Hepatic Vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 Hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified. Results The median survival time (MST) in the pHVTT and mHVTT groups was 5.27 and 3.95years, respectively ( p =0.77), and the median time to recurrence (TTR) was 1.06 and 0.41years, respectively ( p =0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39years and 0.25year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44years, p =0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, p =0.024) and R 1/2 resection (RR 2.08, p =0.017) as risk factors for the overall survival. Conclusions Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function.
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correlation between drainage area volume of middle Hepatic Vein and liver function
Hepato-gastroenterology, 2005Co-Authors: Junichi Kaneko, Yasuhiko Sugawara, Nobuhisa Akamatsu, Yuuichi Matsui, Yoji Kishi, Masatoshi MakuuchiAbstract:Background/Aims: Complete outflow is impossible to maintain on both sides in donors undergoing hemi-liver graft harvesting, because the middle Hepatic Vein (MHV) can be preserved on only one side. The area in which outflow Veins are disrupted becomes congested, and does not sufficiently regenerate. Methodology: The subjects of the study were 55 living donors who provided the left liver with caudate lobe, including the MHV. The midpoint between the tributaries of the MHV and the right Hepatic Vein was determined preoperatively with computed tomography. The midpoint between the tributaries of the MHV and right Hepatic Vein and the borderline between the right and left liver were used to predict the MHV drainage area volume. Total bilirubin levels, the prothrombin time international normalization ratio, and alanine aminotransferase were measured in donors on postoperative days 1, 3, 5 and 7. Results: The parameters that correlated with the MHV drainage area volume included total bilirubin on days 5 and 7, prothrombin time international normalization ratio on day 3, and alanine aminotransferase on day 7. Conclusions: Middle Hepatic Vein drainage area volume, calculated using the present method, correlated with early liver function after left liver harvesting with the MHV.
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effects of middle Hepatic Vein reconstruction on right liver graft regeneration
Transplantation, 2003Co-Authors: Nobuhisa Akamatsu, Yasuhiko Sugawara, Hiroshi Imamura, Keiji Sano, Junichi Kaneko, Norihiro Kokudo, Masatoshi MakuuchiAbstract:Background. A right liver graft without the middle Hepatic Vein (MHV) trunk is now commonly used in living-donor liver transplantation for adult patients. The significance of MHV reconstruction on regeneration or functional recovery of right liver grafts after living-donor liver transplantation, however, remains unclear. Methods. From 2000 to 2002 at the University of Tokyo Hospital in Tokyo, Japan, 56 adult patients received a right liver graft. The patients were divided into three groups by graft type: right liver graft without MHV trunk or MHV reconstruction (n=17); right liver graft without MHV trunk, but with MHV reconstruction (n=27); and extended right liver graft (n=12). Regeneration rate and postoperative liver function were compared among groups. Predictive factors associated with the graft regeneration were identified among clinical variables, including the graft type. Results. The regeneration rate of the right paramedian sector and the whole graft was lowest in the right liver grafts without the MHV trunk or MHV reconstruction. The regeneration rate of the lateral sector was highest in this type of graft, but the difference was not statistically significant. The factors that significantly correlated with the regeneration rate were preoperative graft volume and graft type. There was no significant difference among groups in any of the liver function parameters. Conclusions. In the present series, satisfactory outcome was independent of the type of graft used, which indicates that MHV reconstruction should not be omitted routinely but should be performed in selected patients.
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evaluation of Hepatic venous congestion proposed indication criteria for Hepatic Vein reconstruction
Annals of Surgery, 2002Co-Authors: Keiji Sano, Masatoshi Makuuchi, Yasuhiko Sugawara, Hiroshi Imamura, Kenji Miki, Atsushi Maema, Hidetoshi Matsunami, Tadatoshi TakayamaAbstract:While reduced-size liver transplantation, 1 split liver transplantation, 2 and living donor liver transplantation (LDLT) 3 techniques have almost overcome the graft shortage in pediatric patients with end-stage liver diseases, the disparity between supply and demand is still worsening in adult recipients. 4 LDLT 5 and split-liver transplantation 6 using right and/or left hemiHepatic grafts have been applied to adult patients to increase the number of adult transplants. In LDLT using the right liver, whether the middle Hepatic Vein (MHV) should be preserved for the residual left liver 7 or the right liver graft 8 remains to be clarified. Whether MHV tributaries should be reconstructed in the hemiliver without the MHV is another crucial problem, since a congested area in the right liver graft is reported to result in poor liver function, followed by atrophy, unless venous reconstruction is performed. 9 In hepatectomy for Hepatic tumors with venous involvement, combined resection of the Hepatic Veins should be carried out. However, it is still unclear whether the resected Hepatic Veins should be reconstructed. In this study, we tried to establish the criteria for venous reconstruction of MHV tributaries in adult LDLT using right liver graft. We prospectively evaluated the state of Hepatic congestion and the occurrence of intraHepatic venous anastomoses in the right paramedian sector with occlusion of the MHV by Doppler ultrasonography, temporary clamping of Hepatic artery, and near-infrared spectroscopy (NIRS) using donors for LDLT.
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right liver graft without middle Hepatic Vein reconstruction from a living donor
Transplantation, 2002Co-Authors: Matteo Cescon, Yasuhiko Sugawara, Keiji Sano, Takao Ohkubo, Junji Kaneko, Masatoshi MakuuchiAbstract:A case of adult-to-adult, living-donor liver transplantation using a right liver graft is described. In the donor operation, when the middle Hepatic Vein (MHV) was clamped after Hepatic transection, reversed flow was detected in MHV tributaries by intraoperative color Doppler ultrasonography. Regurgitated flow in the clamped inferior right Hepatic Vein was also demonstrated. Portal flow remained hepatopetal during the procedure. Based on these ultrasonographic findings, neither the MHV tributaries nor the inferior right Hepatic Vein was reconstructed.
Sheung Tat Fan - One of the best experts on this subject based on the ideXlab platform.
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portal inflow and pressure changes in right liver living donor liver transplantation including the middle Hepatic Vein
Liver Transplantation, 2011Co-Authors: See Ching Chan, Boon Hun Yong, Sheung Tat FanAbstract:The middle Hepatic Vein may be included in right liver living donor liver transplantation (LDLT) to optimize Hepatic venous outflow. We studied the graft's ability to relieve portal hypertension and accommodate portal hyperperfusion with portal manometry and ultrasonic flowmetry. Surgical outcomes with respect to portal hemodynamometry were also investigated. The ages of the recipients and donors for 46 consecutive LDLT procedures were 50 (range, 16-66 years) and 31 years (range, 18-54 years), respectively. The graft to standard liver volume ratio was 47.4% (range, 32.4%-69.0%). The hospital mortality rate was 4.4% as 2 recipients died from a subarachnoid hemorrhage and sepsis. The portal pressure dropped by 8 mm Hg (range, −7 to 19 mm Hg) from 23 (range, 8-37 mm Hg) to 14 mm Hg (range, 10-26 mm Hg) after graft implantation. The portal inflow positively correlated with the portal pressure before native liver hepatectomy (R2 = 0.305, P = 0.001) and not with the graft size. The portal inflow increased from 81 mL/minute/100 g (range, 35-210 mL/minute/100 g) before donor right hepatectomy to 318 mL/minute/100 g (range, 102-754 mL/minute/100 g) after graft implantation. The graft portal inflow had a positive linear correlation with the recipient portal pressure before native liver total hepatectomy (R2 = 0.261, P = 0.001) but not after graft implantation, and it had a negative correlation with the graft to standard liver volume ratio (R2 = 0.247, P = 0.001). Only 1 of the graft biopsies showed moderate sinusoidal congestion. Twelve recipients had Clavien grade 2+ complications that were not related to the portal inflow and pressure or graft size. Right liver LDLT including the middle Hepatic Vein effectively lowered the recipient portal pressure by allowing unimpeded venous outflow. Liver Transpl 17:115–121, 2011. © 2011 AASLD
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Caudal shifting of Hepatic Vein anastomosis in right liver living donor liver transplantation
Hepatobiliary & pancreatic diseases international : HBPD INT, 2008Co-Authors: Sheung Tat FanAbstract:BACKGROUND: In right liver living donor liver trans- plantation, Hepatic venous anastomosis is performed using the recipient's right Hepatic Vein orifice. There may be situations that the portal Vein is short or the right liver graft is small, leading to difficulty in portal Vein, Hepatic artery or duct-to-duct anastomosis. METHODS: The recipient's right Hepatic Vein orifice is closed partially for 2 cm at the cranial end or totally, and a new venotomy is made caudal to the right Hepatic Vein orifice. Hepatic Vein anastomsis is performed with the new venotomy. RESULTS: The distance between the liver graft hilum and hepatoduodenal ligament is reduced. Portal Vein, Hepatic artery and biliary anastomosis could be performed without tension or conduit. CONCLUSION: Caudal shifting of Hepatic Vein anastomosis facilitates implantation of a right liver living donor graft.
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precise hepatectomy guided by the middle Hepatic Vein
Hepatobiliary & Pancreatic Diseases International, 2007Co-Authors: Sheung Tat FanAbstract: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.
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safety and necessity of including the middle Hepatic Vein in the right lobe graft in adult to adult live donor liver transplantation
Annals of Surgery, 2003Co-Authors: Sheung Tat Fan, Chileung Liu, Wenxi Wang, John WongAbstract:Right-lobe liver donor liver transplantation (LDLT) is adopted as one of the solutions to overcome the graft shortage in adult patients waiting for liver transplantation.1 However, the major controversy lies in the necessity of including the middle Hepatic Vein in the graft and the safety of the donor. The middle Hepatic Vein lies in the midplane of the liver and drains the right anterior sector and segment IV.2 Inclusion of the middle Hepatic Vein in the right lobe graft ensures adequate and uniform venous drainage of the graft, but it may lead to congestion of the segment IV in the donor. When we initiated the right-lobe LDLT for adults in 1996,3 the middle Hepatic Vein was included in the graft, but other centers feared that the donor risk would be substantially increased and did not include the middle Hepatic Vein in the graft.4–7 In this study, we analyzed the outcome of the donors who had donated the middle Hepatic Vein in the graft to determine whether the inclusion of the middle Hepatic Vein is safe. We also analyzed the outcome of the recipients who had the graft middle Hepatic Vein occluded to determine whether the middle Hepatic Vein is necessary for achieving a better early graft function.
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Hepatic venoplasty in living donor liver transplantation using right lobe graft with middle Hepatic Vein
Transplantation, 2003Co-Authors: Sheung Tat Fan, Chileung Liu, John WongAbstract:Inclusion of the middle Hepatic Vein in a right lobe graft from a living-donor may improve venous drainage and avoid graft dysfunction, but reconstruction of the middle Hepatic Vein is technically difficult. We developed a Hepatic venoplasty technique, which was applied in eight consecutive right lobe liver transplantations. The right and middle Hepatic Veins of the graft were joined together to form a triangular cuff for a single anastomosis to the recipient's inferior vena cava. Hepatic venoplasty was successful in all cases, and no interposition graft was required. Venovenous bypass was not used. All grafts showed immediate function, and no Hepatic venous outflow obstruction was observed. There was no reoperation and the graft survival rate was 100%. This Hepatic venoplasty technique can be applied systemically as a standard one in right lobe liver graft with the middle Hepatic Vein to simplify the recipient hepatectomy and to obviate venous outflow obstruction.
Norihiro Kokudo - One of the best experts on this subject based on the ideXlab platform.
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reconstruction of Hepatic venous tributary in right liver living donor liver transplantation the importance of the inferior right Hepatic Vein
Liver Transplantation, 2016Co-Authors: Kyoji Ito, Kiyoshi Hasegawa, Nobuhisa Akamatsu, Junichi Kaneko, Yoshihiro Sakamoto, Keigo Tani, Daisuke Ito, Junichi Arita, Norihiro KokudoAbstract:Special care must be taken in Hepatic Vein reconstruction to avoid outflow block in living donor liver transplantation (LDLT) with a right liver graft. We have used cryopreserved homologous Veins to reconstruct the right Hepatic Vein (RHV), middle Hepatic Vein (MHV), MHV tributaries (V5 and V8), and inferior right Hepatic Vein (IRHV). The reconstruction of V5, V8, and IRHV was based on the estimated congestive volume, calculated by the computed tomography volumetry, to secure the functional graft volume of 40% of the recipient standard liver volume. Among 262 right liver LDLT recipients, the number of reconstructed RHVs, MHVs, V5s, V8s, and IRHVs was 262, 48, 110, 111, and 147, respectively, and the overall patency was 95%, 100%, 36%, 58%, and 86%, respectively. Although the patency of the RHVs and MHVs was satisfactory, that of the V5s, V8s, and IRHVs was suboptimal. Patency of the IRHVs (86%, 126/147) was significantly better than that of both V5s (36%, 40/110) and V8s (58%, 64/111; P < 0.001). In addition, the estimated volume drained by IRHVs was significantly greater than that of V5s and V8s (IRHV, 176 ± 92 mL; V5, 105 ± 49 mL; V8, 127 ± 60 mL; P < 0.001). The patency of IRHV was significantly improved by applying the double inferior vena cava method (93%, 94/101) when compared to the direct anastomosis to vena cava (68%, 25/37; P < 0.001). The IRHV functioned as a main drainage route in cases of an obstructed RHV. In conclusion, reconstruction of the IRHV is recommended, not only to improve the functional reserve of the graft, but also to secure multiple drainage routes of the graft.
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surgical treatment of hepatocellular carcinoma associated with Hepatic Vein tumor thrombosis
Journal of Hepatology, 2014Co-Authors: Takashi Kokudo, Masatoshi Makuuchi, Yasuhiko Sugawara, Kiyoshi Hasegawa, Satoshi Yamamoto, Junichi Shindoh, Nobuyuki Takemura, Taku Aoki, Yoshihiro Sakamoto, Norihiro KokudoAbstract:Background & Aims Presence of Hepatic Vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT. Methods Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analysed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral Hepatic Vein, including microscopic invasion (pHVTT), tumor thrombosis in a major Hepatic Vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 Hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified. Results The median survival time (MST) in the pHVTT and mHVTT groups was 5.27 and 3.95years, respectively ( p =0.77), and the median time to recurrence (TTR) was 1.06 and 0.41years, respectively ( p =0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39years and 0.25year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44years, p =0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, p =0.024) and R 1/2 resection (RR 2.08, p =0.017) as risk factors for the overall survival. Conclusions Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function.
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effects of middle Hepatic Vein reconstruction on right liver graft regeneration
Transplantation, 2003Co-Authors: Nobuhisa Akamatsu, Yasuhiko Sugawara, Hiroshi Imamura, Keiji Sano, Junichi Kaneko, Norihiro Kokudo, Masatoshi MakuuchiAbstract:Background. A right liver graft without the middle Hepatic Vein (MHV) trunk is now commonly used in living-donor liver transplantation for adult patients. The significance of MHV reconstruction on regeneration or functional recovery of right liver grafts after living-donor liver transplantation, however, remains unclear. Methods. From 2000 to 2002 at the University of Tokyo Hospital in Tokyo, Japan, 56 adult patients received a right liver graft. The patients were divided into three groups by graft type: right liver graft without MHV trunk or MHV reconstruction (n=17); right liver graft without MHV trunk, but with MHV reconstruction (n=27); and extended right liver graft (n=12). Regeneration rate and postoperative liver function were compared among groups. Predictive factors associated with the graft regeneration were identified among clinical variables, including the graft type. Results. The regeneration rate of the right paramedian sector and the whole graft was lowest in the right liver grafts without the MHV trunk or MHV reconstruction. The regeneration rate of the lateral sector was highest in this type of graft, but the difference was not statistically significant. The factors that significantly correlated with the regeneration rate were preoperative graft volume and graft type. There was no significant difference among groups in any of the liver function parameters. Conclusions. In the present series, satisfactory outcome was independent of the type of graft used, which indicates that MHV reconstruction should not be omitted routinely but should be performed in selected patients.
P Chabrot - One of the best experts on this subject based on the ideXlab platform.
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combined preoperative portal and Hepatic Vein embolization biembolization to improve liver regeneration before major liver resection a preliminary report
World Journal of Surgery, 2017Co-Authors: Bertrand Le Roy, Antoine Perrey, Mikael Fontarensky, Johan Gagniere, Armand Abergel, Bruno Pereira, Celine Lambert, L Boyer, Denis Pezet, P ChabrotAbstract:Insufficient volume of the future liver remnant (FLR) is a major cause of non-resectable disease in patients presenting with primary or metastatic liver tumours. The objective of this study was to evaluate the safety and efficacy of the combined preoperative portal and Hepatic Vein embolization (biembolization) before extended right liver resections. This retrospective study was performed in a tertiary centre between 2014 and 2015. Combined right portal and Hepatic Vein embolization (biembolization) was proposed, as an alternative to ALPPS procedure, for all patients with primary or metastatic liver tumour, before right extended hepatectomy. CT scan liver volumetry was assessed before biembolization, three weeks after biembolization and one week after surgery. Seven patients underwent biembolization. All patients had right portal Vein embolization (PVE) combined with right Hepatic Vein embolization (HVE, n = 4), median HVE (n = 2) and right + median HVE (n = 1). Three patients had preoperative liver disease and two received preoperative chemotherapy. No biembolization procedure-related complications occurred. The mean FLR regeneration rate was 52.6% (range: 18.2–187.9) after the biembolization. One patient with gallbladder carcinoma was not operated because of peritoneal carcinomatosis diagnosed after the biembolization. The remnant six patients did not develop postoperative liver failure. Biembolization seems to induce safe, reproducible and effective FLR growth before extended right hepatectomy, in patients with primary or metastatic liver tumour.
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combined preoperative portal and Hepatic Vein embolization biembolization to improve liver regeneration before major liver resection a preliminary report
World Journal of Surgery, 2017Co-Authors: Bertrand Le Roy, Antoine Perrey, Mikael Fontarensky, Johan Gagniere, Armand Abergel, Bruno Pereira, Celine Lambert, L Boyer, Denis Pezet, P ChabrotAbstract:Background Insufficient volume of the future liver remnant (FLR) is a major cause of non-resectable disease in patients presenting with primary or metastatic liver tumours. The objective of this study was to evaluate the safety and efficacy of the combined preoperative portal and Hepatic Vein embolization (biembolization) before extended right liver resections.