- Email: [email protected]
Isolated caudate lobe resection for hepatocellular carcinoma: A single center experience of 43 patients
Electronic Poster Abstracts
EP01C-040 SURGICAL OUTCOMES AFTER LAPAROSCOPIC MAJOR HEPATECTOMY FOR VARIOUS LIVER DISEASES S. -H. Kim, C. -S. Ahn, T. -Y. Ha, S. Hwang, D. -H. Jung, K. -H. Kim, S. -G. Lee, D. -B. Moon, G. -W. Song, G. -C. Park and J. -H. Kwon Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine / Asan Medical Center, Republic of Korea Background: Laparoscopic liver resection has been more frequently performed than before, but expansion of laparoscopic major hepatic resection is still limited primarily due to the technical difficulties compared to open surgery. The aim of this study was to describe our experiences of 192 patients undergoing laparoscopic major hepatectomy for various liver diseases. Methods: We reviewed a clinicopathological data of 192 patients who underwent laparoscopic major hepatectomy between October 2007 and March 2015 at Asan medical center. Results: The mean age of the patients was 54 years and mean BMI was 23.5. The mean operation time was 272 minutes and mean estimated blood loss was 300mL. The most common indications were Hepatocellular carcinoma (n = 82,42.7%), followed by intrahepatic duct stones (n = 51,26.6%). We performed 108 left hepatectomies, 55 right hepatectomies, 18 right posterior sectionectomies,6 right anterior sectionectomy,2 central bisectionectomy and 3 pure laparoscopic donor right hepatectomy. Three patients were converted to open because of bleeding, bile leakage and uncontrolled hypercapnea during operation. Postoperative complications occurred in 8 patients (4.2%) and there were no deaths. The mean postoperative hospital stay was 9.8 days. For patients with malignant tumors, there were no positive resection margins. Conclusions: We concluded that laparoscopy can be safely and effectively applicable for major hepatectomy after candidate selection. However, prospective randomized studies with a great number of cases are needed to confirm the role of laparoscopy in major hepatic resection.
EP01C-041 ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY (ALPPS): PRELIMINARY RESULTS OF A SINGLE CENTER EXPERIENCE IN SANTIAGO, CHILE S. A. Uribe-Echevarría1, M. Uribe M.1, F. Riquelme M.1, C. Mandiola B.2, M. I. Zapata F.1 and P. Romanque1 1 Servicio de Cirugía, Hospital del Salvador, and 2Faculty of Medicine, University of Chile, Chile Introduction: ALPPS has been recently introduced for liver volume augmentation in cases of right hepatectomy
HPB 2016, 18 (S1), e1ee384
e239
with insufficient future remnant liver volumen (RLV) and high risk of liver failure. We retrospectively analyzed our experience with ALPPS in order to evaluate the application of the procedure. Method: Patients referred to Hospital del Salvador with liver metastases from colorectal cancer between October 2011eApril 2015 were included, according to eligibility and exclusion criteria. In first stage, right portal vein was ligated and liver split in the limit of IIeIII segments along falciform ligament. Volume gain was followed-up with CT-scan where was evaluated RLV, total liver volume (TLV), remnant liver volume to body weight (RLV/BW) ratio and median volume gain. Perioperative morbidity was classified according Clavien-Dindo classification. Results: 13 ALPPS procedures were performed, 7 male and 6 female patients aged 40 to 70 years. The preoperative RLV/BW ratio was < 0.5 with RLV range from 180e473 ml. After ALPPS the RLV increased up to 96,8% (35e214%, p < 0.05) in 19 days (7e89), equivalent to 30,07 13,7 ml/day. Grade Clavien-Dindo IIIB complications occurred in 23% (3/13) of patients including hematoma of abdominal wall and intra-abdominal sepsis with surgical management, and a reversible postoperative liver failure. There was no ninety-day mortality. Conclusions: A significant volume increased was achieved with ALPPS in a period shorter than the time required to achieve similar liver augmentation with portal embolization/ligation, decreasing the risk of insufficient hypertrophy and chances of tumoral progression. Selection of candidates and morbidity/mortality rates require a careful interdisciplinary assessment.
EP01C-043 ISOLATED CAUDATE LOBE RESECTION FOR HEPATOCELLULAR CARCINOMA: A SINGLE CENTER EXPERIENCE OF 43 PATIENTS H. -D. Cho, K. -H. Kim, S. -G. Lee, S. Hwang, C. -S. Ahn, D. -B. Moon, T. -Y. Ha, G. -W. Song, S. -H. Kim, J. -H. Kwon and E. -K. Jwa Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Republic of Korea Background: Caudate lobe resection is relatively difficult rather than other hepatic surgery because of its deep location and adjacent major vascular structures. The objective of this study was to evaluate the safety, efficiency and complication associated caudate lobe resection for hepatocellular carcinoma. Methods: From December 2001 to July 2014, isolated caudate lobe resections (ICLR) for hepatocellular carcinoma which were performed in Asan Medical Center were investigated. Patient demographics, preoperative data, clinical perioperative outcomes, and tumor characteristics were identified by a medical chart review. Result: Forty-three patient (mean age 54.3 years) underwent ICLR for hepatocellular carcinoma during study period. Eight of them were female (male: female = 35:8).
e240
Electronic Poster Abstracts
Nineteen patients underwent total isolated caudate lobe resection, seventeen patients underwent Spiegel lobe resection, four patients underwent caudate process resection, and three patients underwent paracaval portion resection. The mean operative time was 222 127.7 minutes and the mean estimated intraoperative blood loss was 523.6 141.6 mL. There was one perioperative death, and postoperative complication rate was 16.3% (7/43). Conclusion: ICLR is difficult technically but proper surgical approach in patient with sufficient liver function reserve ensures that ICLR is safe and curative surgery.
EP01C-044 RISK FACTORS OF OPEN CONVERSION IN LAPAROSCOPIC LIVER RESECTION e A SINGLE CENTER STUDY W. Cho, C. H. Kwon, J. W. Joh, S. J. Kim, G. S. Choi, N. Lee and C. W. Cho Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea Introduction: Laparoscopic liver resection (LLR) is used world widely in recent year and many centers planned to start the procedure. But because of the technical difficulty, it is important to set the operative indication in early time. The open conversion rate is main parameters for assessing surgical performance. We evaluated risk factors of open conversion in LLR. Methods: From Jan 2004 to Feb 2015, a total 672 cases of laparoscopic procedure were retrospectively reviewed. Results: Significant risk factor of open conversion were major hepatectomy (9.7% major versus 5.9% minor hepatectomy, p = 0.030), malignancy (8.0% malignancy vs. 3.2% benign, p = 0.043), posterior-superior (PS) location of the lesion (11.6% PS vs. 4.9% the others, p = 0.003), and patient BMI (p = 0.037). Conclusion: The risk factors of open conversion were closely related with the degree of technical difficulties. Risk factor evaluation and patient selection will be needed according to experiences.
EP01C-045 SURVIVAL AFTER LIVER TRANSPLANTATION IN PATIENTS WITH AND WITHOUT HEPATOCELLULAR CARCINOMA: A COMPARATIVE STUDY F. Ferreira Rios1, P. Lisboa Bittencourt2, L. Codes2, J. L. Bastos1,2, J. Rodrigues de Freitas3, L. A. Rodrigues de Freitas3 and R. Paraná1 1 Faculdade de Medicina da Bahia, Universidade Federal da Bahia, 2Unidade de Gastroenterologia e Hepatologia, Hospital Português, and 3Patologia, Fundação Oswaldo Cruz, LPBI e Centro de Pesquisas Gonçalo Moniz, Brazil Introduction: The liver transplantation (LT) is the best therapeutic option for hepatocellular carcinoma (HCC). Objective; compare the survival rate after the liver transplant in patients with and without HCC.
Method: 62 patients with HCC and 211 without HCC, were submitted to LT in our unit, between 2001 and 2013. The survival and the variables pre, intra and post-surgery of the patients with and without HCC were compared. Results: The patients with HCC were older (59 7.1 versus 48.2 12.9 years P < 0.001), their liver function was better (Child-Pugh class C: 13.6% versus 34%; P < 0.001), presented less MELD physiological score (15: 70.5% versus 29% P < 0.001). They presented more frequency of hepatitis virus C, diabetes and systemic arterial hypertension (P < 0.05) in the pre-transplant than the patients without HCC. Only the patients without HCC were submitted to a new transplant. The survival of the patients with HCC was significantly less when compared to the patients without HCC in 1, 3 and 5 years (73%, 71% and 71% versus 89%, 85% and 85% respectively, P < 0.03). The presence of sepsis in the post-operative is correlated independently, with worse survival (P = 0.042; OR 10.846; CI 1.023e3.3), in both groups. The main death cause in long-term was the HCC recurrence (47.5%) and septic shock (47%) in patients with and without HCC, respectively. Conclusions: The survival of the patients with HCC was significantly less when compared to the patients without HCC. We observed important differences in the variables studied between the two groups.
EP01C-046 EARLY IDENTIFICATION OF PATIENTS AT INCREASED RISK OF LIVER FAILURE, POSTOPERATIVE COMPLICATIONS AND DEATH AFTER MAJOR HEPATECTOMY E. Bonati1, T. Francesco1, G. Pedrazzi2, M. Iaria1 and R. Dalla Valle1 1 Department of Surgery, Division of General Surgery and Organ Transplantation, and 2Department of Neuroscience, Parma University Hospital, Italy Introduction: Aim of this study was to identify early predictive markers of clinically significant liver failure (PHLF B/C), postoperative complications and mortality after major liver resections. Materials and methods: 115 consecutive major hepatectomies (three or more segments) were carried out and retrospectively analyzed. Association beetween PHLF, major complications, in-hospital mortality, demographics, clinical-pathologic and perioperative factors was evaluated. Multivariate logistic regression analysis was used to develop a predictive model for PHLF B/C, Clavien-Dindo grades III-V complications and mortality. Sensitivity, specificity and the area under the receiver operating characteristic (AUROC) curve were assessed. Results: PHLF B/C was observed in 25 of 115 (21.7%) patients. 41 (35.7%) developed major complications, inhospital mortality was 3.5% (4 patients). Multivariate logistic regression analysis identified high serum bilirubin and increased prothrombin time (PT) ratio on postoperative day 3 (POD3) as indipendent predictive markers of PHLF B/C (P < 0.05). POD3 high serum bilirubin was the only early postoperative factor influencing the risk of
HPB 2016, 18 (S1), e1ee384
EP01C-040 SURGICAL OUTCOMES AFTER LAPAROSCOPIC MAJOR HEPATECTOMY FOR VARIOUS LIVER DISEASES S. -H. Kim, C. -S. Ahn, T. -Y. Ha, S. Hwang, D. -H. Jung, K. -H. Kim, S. -G. Lee, D. -B. Moon, G. -W. Song, G. -C. Park and J. -H. Kwon Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine / Asan Medical Center, Republic of Korea Background: Laparoscopic liver resection has been more frequently performed than before, but expansion of laparoscopic major hepatic resection is still limited primarily due to the technical difficulties compared to open surgery. The aim of this study was to describe our experiences of 192 patients undergoing laparoscopic major hepatectomy for various liver diseases. Methods: We reviewed a clinicopathological data of 192 patients who underwent laparoscopic major hepatectomy between October 2007 and March 2015 at Asan medical center. Results: The mean age of the patients was 54 years and mean BMI was 23.5. The mean operation time was 272 minutes and mean estimated blood loss was 300mL. The most common indications were Hepatocellular carcinoma (n = 82,42.7%), followed by intrahepatic duct stones (n = 51,26.6%). We performed 108 left hepatectomies, 55 right hepatectomies, 18 right posterior sectionectomies,6 right anterior sectionectomy,2 central bisectionectomy and 3 pure laparoscopic donor right hepatectomy. Three patients were converted to open because of bleeding, bile leakage and uncontrolled hypercapnea during operation. Postoperative complications occurred in 8 patients (4.2%) and there were no deaths. The mean postoperative hospital stay was 9.8 days. For patients with malignant tumors, there were no positive resection margins. Conclusions: We concluded that laparoscopy can be safely and effectively applicable for major hepatectomy after candidate selection. However, prospective randomized studies with a great number of cases are needed to confirm the role of laparoscopy in major hepatic resection.
EP01C-041 ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION FOR STAGED HEPATECTOMY (ALPPS): PRELIMINARY RESULTS OF A SINGLE CENTER EXPERIENCE IN SANTIAGO, CHILE S. A. Uribe-Echevarría1, M. Uribe M.1, F. Riquelme M.1, C. Mandiola B.2, M. I. Zapata F.1 and P. Romanque1 1 Servicio de Cirugía, Hospital del Salvador, and 2Faculty of Medicine, University of Chile, Chile Introduction: ALPPS has been recently introduced for liver volume augmentation in cases of right hepatectomy
HPB 2016, 18 (S1), e1ee384
e239
with insufficient future remnant liver volumen (RLV) and high risk of liver failure. We retrospectively analyzed our experience with ALPPS in order to evaluate the application of the procedure. Method: Patients referred to Hospital del Salvador with liver metastases from colorectal cancer between October 2011eApril 2015 were included, according to eligibility and exclusion criteria. In first stage, right portal vein was ligated and liver split in the limit of IIeIII segments along falciform ligament. Volume gain was followed-up with CT-scan where was evaluated RLV, total liver volume (TLV), remnant liver volume to body weight (RLV/BW) ratio and median volume gain. Perioperative morbidity was classified according Clavien-Dindo classification. Results: 13 ALPPS procedures were performed, 7 male and 6 female patients aged 40 to 70 years. The preoperative RLV/BW ratio was < 0.5 with RLV range from 180e473 ml. After ALPPS the RLV increased up to 96,8% (35e214%, p < 0.05) in 19 days (7e89), equivalent to 30,07 13,7 ml/day. Grade Clavien-Dindo IIIB complications occurred in 23% (3/13) of patients including hematoma of abdominal wall and intra-abdominal sepsis with surgical management, and a reversible postoperative liver failure. There was no ninety-day mortality. Conclusions: A significant volume increased was achieved with ALPPS in a period shorter than the time required to achieve similar liver augmentation with portal embolization/ligation, decreasing the risk of insufficient hypertrophy and chances of tumoral progression. Selection of candidates and morbidity/mortality rates require a careful interdisciplinary assessment.
EP01C-043 ISOLATED CAUDATE LOBE RESECTION FOR HEPATOCELLULAR CARCINOMA: A SINGLE CENTER EXPERIENCE OF 43 PATIENTS H. -D. Cho, K. -H. Kim, S. -G. Lee, S. Hwang, C. -S. Ahn, D. -B. Moon, T. -Y. Ha, G. -W. Song, S. -H. Kim, J. -H. Kwon and E. -K. Jwa Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Republic of Korea Background: Caudate lobe resection is relatively difficult rather than other hepatic surgery because of its deep location and adjacent major vascular structures. The objective of this study was to evaluate the safety, efficiency and complication associated caudate lobe resection for hepatocellular carcinoma. Methods: From December 2001 to July 2014, isolated caudate lobe resections (ICLR) for hepatocellular carcinoma which were performed in Asan Medical Center were investigated. Patient demographics, preoperative data, clinical perioperative outcomes, and tumor characteristics were identified by a medical chart review. Result: Forty-three patient (mean age 54.3 years) underwent ICLR for hepatocellular carcinoma during study period. Eight of them were female (male: female = 35:8).
e240
Electronic Poster Abstracts
Nineteen patients underwent total isolated caudate lobe resection, seventeen patients underwent Spiegel lobe resection, four patients underwent caudate process resection, and three patients underwent paracaval portion resection. The mean operative time was 222 127.7 minutes and the mean estimated intraoperative blood loss was 523.6 141.6 mL. There was one perioperative death, and postoperative complication rate was 16.3% (7/43). Conclusion: ICLR is difficult technically but proper surgical approach in patient with sufficient liver function reserve ensures that ICLR is safe and curative surgery.
EP01C-044 RISK FACTORS OF OPEN CONVERSION IN LAPAROSCOPIC LIVER RESECTION e A SINGLE CENTER STUDY W. Cho, C. H. Kwon, J. W. Joh, S. J. Kim, G. S. Choi, N. Lee and C. W. Cho Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea Introduction: Laparoscopic liver resection (LLR) is used world widely in recent year and many centers planned to start the procedure. But because of the technical difficulty, it is important to set the operative indication in early time. The open conversion rate is main parameters for assessing surgical performance. We evaluated risk factors of open conversion in LLR. Methods: From Jan 2004 to Feb 2015, a total 672 cases of laparoscopic procedure were retrospectively reviewed. Results: Significant risk factor of open conversion were major hepatectomy (9.7% major versus 5.9% minor hepatectomy, p = 0.030), malignancy (8.0% malignancy vs. 3.2% benign, p = 0.043), posterior-superior (PS) location of the lesion (11.6% PS vs. 4.9% the others, p = 0.003), and patient BMI (p = 0.037). Conclusion: The risk factors of open conversion were closely related with the degree of technical difficulties. Risk factor evaluation and patient selection will be needed according to experiences.
EP01C-045 SURVIVAL AFTER LIVER TRANSPLANTATION IN PATIENTS WITH AND WITHOUT HEPATOCELLULAR CARCINOMA: A COMPARATIVE STUDY F. Ferreira Rios1, P. Lisboa Bittencourt2, L. Codes2, J. L. Bastos1,2, J. Rodrigues de Freitas3, L. A. Rodrigues de Freitas3 and R. Paraná1 1 Faculdade de Medicina da Bahia, Universidade Federal da Bahia, 2Unidade de Gastroenterologia e Hepatologia, Hospital Português, and 3Patologia, Fundação Oswaldo Cruz, LPBI e Centro de Pesquisas Gonçalo Moniz, Brazil Introduction: The liver transplantation (LT) is the best therapeutic option for hepatocellular carcinoma (HCC). Objective; compare the survival rate after the liver transplant in patients with and without HCC.
Method: 62 patients with HCC and 211 without HCC, were submitted to LT in our unit, between 2001 and 2013. The survival and the variables pre, intra and post-surgery of the patients with and without HCC were compared. Results: The patients with HCC were older (59 7.1 versus 48.2 12.9 years P < 0.001), their liver function was better (Child-Pugh class C: 13.6% versus 34%; P < 0.001), presented less MELD physiological score (15: 70.5% versus 29% P < 0.001). They presented more frequency of hepatitis virus C, diabetes and systemic arterial hypertension (P < 0.05) in the pre-transplant than the patients without HCC. Only the patients without HCC were submitted to a new transplant. The survival of the patients with HCC was significantly less when compared to the patients without HCC in 1, 3 and 5 years (73%, 71% and 71% versus 89%, 85% and 85% respectively, P < 0.03). The presence of sepsis in the post-operative is correlated independently, with worse survival (P = 0.042; OR 10.846; CI 1.023e3.3), in both groups. The main death cause in long-term was the HCC recurrence (47.5%) and septic shock (47%) in patients with and without HCC, respectively. Conclusions: The survival of the patients with HCC was significantly less when compared to the patients without HCC. We observed important differences in the variables studied between the two groups.
EP01C-046 EARLY IDENTIFICATION OF PATIENTS AT INCREASED RISK OF LIVER FAILURE, POSTOPERATIVE COMPLICATIONS AND DEATH AFTER MAJOR HEPATECTOMY E. Bonati1, T. Francesco1, G. Pedrazzi2, M. Iaria1 and R. Dalla Valle1 1 Department of Surgery, Division of General Surgery and Organ Transplantation, and 2Department of Neuroscience, Parma University Hospital, Italy Introduction: Aim of this study was to identify early predictive markers of clinically significant liver failure (PHLF B/C), postoperative complications and mortality after major liver resections. Materials and methods: 115 consecutive major hepatectomies (three or more segments) were carried out and retrospectively analyzed. Association beetween PHLF, major complications, in-hospital mortality, demographics, clinical-pathologic and perioperative factors was evaluated. Multivariate logistic regression analysis was used to develop a predictive model for PHLF B/C, Clavien-Dindo grades III-V complications and mortality. Sensitivity, specificity and the area under the receiver operating characteristic (AUROC) curve were assessed. Results: PHLF B/C was observed in 25 of 115 (21.7%) patients. 41 (35.7%) developed major complications, inhospital mortality was 3.5% (4 patients). Multivariate logistic regression analysis identified high serum bilirubin and increased prothrombin time (PT) ratio on postoperative day 3 (POD3) as indipendent predictive markers of PHLF B/C (P < 0.05). POD3 high serum bilirubin was the only early postoperative factor influencing the risk of
HPB 2016, 18 (S1), e1ee384