China
Africa
Explore chapters and articles related to this topic
Multimodality management of metastatic neuroendocrine tumors
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Parissa Tabrizian, Yaniv Berger, Daniel M. Labow
In patients with normal liver parenchyma and function, a future liver remnant volume of 25%–30% is considered adequate. In patients with chronic liver disease, cirrhosis, or documented hepatic steatosis, a future liver remnant volume of 40%–50% is desired. Preoperative portal vein embolization or portal vein ligation may be used to induce growth of the future liver remnant when hepatic reserve is borderline and major resection is anticipated.
Hepatocellular Carcinoma
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Masakazu Yamamoto, Shun-ichi Ariizumi
The patient was older than 80 years with comorbidities. Therefore, previous gastroenterologists did not recommend surgery. However, treatment of hepatocellular carcinoma with radiofrequency ablation and transarterial chemoembolization failed, and the size of the tumor and the tumor marker levels increased after treatment. Fortunately, the tumor did not have intrahepatic metastasis or portal vein invasion at the time of referral to our department. The patient was therefore investigated further. Blood chemistry test results were: hepatitis B antigen negative, hepatitis C virus antibody negative, hemoglobin level 12 mg/dL, platelet 14.3 10~4/μL, prothrombin time 76.9%, total bilirubin level 0.9 mg/dL, albumin level 3.3 g/dL, AST 31 U/L, ALT 59 U/L, creatinine 1.06 mg/dL, alpha fetoprotein 26067 ng/dl, PIVKA-II 1367 mAU/ml. Child-Pugh class was evaluated as A (point 6) and ICG-R15 12%. MDCT showed a 10 cm hepatocellular carcinoma in the right liver. The tumor was attached to the right hepatic vein and the right anterior portal vein (Figure 33.2). There was neither intrahepatic metastases nor portal vein tumor thrombus. According to 3D-CT, the right liver volume without the tumor was 434 ml and the remnant left liver volume was 333 ml. The hepatic resection volume was 57% (Figure 33.3). The allowable hepatic resection was 58% by Takasaki’s log table if the future ICG-R15 in the remnant liver was predicted to be less than 40% (Figure 33.1). Portal vein embolization before surgery does therefore not need to be considered. The patient underwent right hepatectomy in April 2019 (Figure 33.4) and he was discharged from the hospital on the 14th day after surgery without complications. The macroscopic findings showed a 10 cm hepatocellular carcinoma (Figure 33.5) and the pathological findings yielded a diagnosis of poorly differentiated hepatocellular carcinoma with liver cirrhosis.
Development of cisplatin-loaded hydrogels for trans-portal vein chemoembolization in an orthotopic liver cancer mouse model
Published in Drug Delivery, 2021
Xinxiang Yang, Wai-Ho Oscar Yeung, Kel Vin Tan, Tak-Pan Kevin Ng, Li Pang, Jie Zhou, Jinyang Li, Changxian Li, Xiangcheng Li, Chung Mau Lo, Weiyuan John Kao, Kwan Man
After the in situ-photopolymerization of IPN in the left portal vein, severe massive hepatic necrosis in the left lobe of liver was formed (Figure 1(A)). Ischemic injury resulted in periportal and confluent necrosis, where the hepatocytes were replaced by fragments of nucleuses from dead hepatocytes and infiltrated inflammatory cells, involving in multiple hepatic lobules in the left lobe at 24 hours after IPN hydrogel injection (Figure 1(A)). The liver necrosis decreased 7 days later as compared to subacute phase (24 hours) (Figure 1(A)). However, neither inflammation nor necrosis was found in the lung and heart at 24 hours and 7 days (Figure 1(A)). The portal vein anatomy was scanned by MRI at different time points after portal vein embolization. Both T2 weighted and T1 weighted axial MRI images showed that the left branch of portal vein was completely blocked at 2 hours (Figure 1(B)). Afterwards, fading of IPN hydrogels in the left portal vein was observed 24 hours after embolization (Figure 1(B)). These findings indicated that IPN hydrogels blocked the left portal vein in a short term immediately after polymerization and gradually degraded and flowed into the liver to induce severe ischemia injury in the left lobe of the liver.
Fatty liver disease and primary liver cancer: disease mechanisms, emerging therapies and the role of bariatric surgery
Published in Expert Opinion on Investigational Drugs, 2020
Luke V. Selby, Aslam Ejaz, Stacy A. Brethauer, Timothy M. Pawlik
The treatment of primary liver cancer is surgical. All patients diagnosed with HCC should be evaluated at a high-volume multidisciplinary liver center [26]. Patients with a single solitary mass without major vascular invasion and an adequate functional liver remnant are candidates for primary resection. Patients with a borderline functional liver remnant can be considered for pre-operative portal vein embolization or other advanced techniques to improve the size and functionality of the future liver remnant [27]. Patients with limited and resectable multifocal disease or major vascular resection may be candidates for resection in the setting of a prospective protocol evaluating this strategy, and situational utilization of advanced surgical techniques may be indicated. Similarly, patients with cholangiocarcinoma that are physiologically able to undergo a hepatectomy and have a suitable future liver remnant should be considered for surgical resection.
Current status of robotic surgery for hepato-pancreato-biliary malignancies
Published in Expert Review of Anticancer Therapy, 2022
Marcus Bahra, Ramin Raul Ossami Saidy
Oncological indications for liver surgery mainly consist of neoplasms with a hepatic origin such as hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA) and – due to improvement in oncological therapy – rising numbers of secondary liver tumors, especially colorectal liver metastases (CRLM). With the introduction of multimodal concepts that enable major liver surgery in otherwise irresectable cases, e.g. portal vein embolization (PVE) or associating liver partition with portal vein ligation for staged hepatectomy (ALPPS), surgical indications were expanded [6].