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Liver Remnant (liver + remnant)
Kinds of Liver Remnant Selected AbstractsCholangiocarcinoma: preoperative biliary drainage (Con)HPB, Issue 2 2008A. LAURENT Aim. In patients with malignant hilar obstruction, liver resection is associated with an increased risk of postoperative liver failure attributed to the need for major liver resection in a context of obstructive jaundice. To overcome this issue, most authors recommend preoperative biliary drainage (PBD). However, PBD carries risks of its own, including, primarily, sepsis and, more rarely, tumor seeding, bile peritonitis, and hemobilia. We, unlike most authors, have not used routine PBD before liver resection in jaundiced patients. Material and methods. Our series includes 62 patients who underwent major liver resection for cholangiocarcinoma; 33 of these had elevated bilurubin (60,470 µmol/l) and were operated without PBD. There were 43 extended right hepatectomies and 18 extended left hepatectomies. Results. Hospital deaths occurred in 5 patients (8%) including 3 of 33 jaundiced patients (9%, ns). All deaths occurred after extended right hepatectomy (12%), including 3 patients with a serum bilirubin level above 300 µmol/l and 2 with normal bilirubin. There were no deaths after left-sided resections, whatever the level of bilirubin. Conclusions. PBD can be omitted in the following situations: recent onset jaundice (<2,3 weeks), total bilirubin <200 µmol/l, no previous endoscopic or transhepatic cholangiography, absence of sepsis, future liver remnant >40%. These criteria include most patients requiring left-sided resections and selected patients requiring right-sided resections. In other cases, PBD is required, associated with portal vein embolization in the event of a small future liver remnant. [source] Hilar cholangiocarcinoma: diagnosis and stagingHPB, Issue 4 2005William Jarnagin Cancer arising from the proximal biliary tree, or hilar cholangiocarcinoma, remains a difficult clinical problem. Significant experience with these uncommon tumors has been limited to a small number of centers, which has greatly hindered progress. Complete resection of hilar cholangiocarcinoma is the most effective and only potentially curative therapy, and it now clear that concomitant hepatic resection is required in most cases. Simply stated, long-term survival is generally possible only with an en bloc resection of the liver with the extrahepatic biliary apparatus, leaving behind a well perfused liver remnant with adequate biliary-enteric drainage. Preoperative imaging studies should aim to assess this possibility and must evaluate a number of tumor-related factors that influence resectability. Advances in imaging technology have improved patient selection, but a large proportion of patients are found to have unresectable disease only at the time of exploration. Staging laparoscopy and 13fluoro-deoxyglucose positron emission tomography (FDG-PET) may help to identify some patients with advanced disease; however, local tumor extent, an equally critical determinant of resectability, may be underestimated on preoperative studies. This paper reviews issues pertaining to diagnosis and preoperative evaluation of patients with hilar biliary obstruction. Knowledge of the imaging features of hilar tumors, particularly as they pertain to resectability, is of obvious importance for clinicians managing these patients. [source] Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinomaHPB, Issue 4 2005Jacques Belghiti Optimal preoperative preparation is required to reduce operative risk of major hepatectomy in jaundiced patients. The role of percutaneous preoperative biliary drainage (PTBD) is, apart from assessment of intraductal extent of the tumour, to allow contralateral hypertrophy if portal vein embolization (PVE) is performed. The increased use of PTBD over a 10-year period was associated with increased resectability rate in this study, while PTBD-related complications decreased. Efficient hypertrophy of the future liver remnant (FLR) requires biliary drainage to reduce the risk of postoperative liver dysfunction. Preoperative staging laparoscopy avoided unnecessary surgical exploration in 20% of patients previously considered resectable. [source] Review article: multimodality treatment of liver metastases increases suitability for surgical treatmentALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2007K. P. DE JONG Summary Background Liver metastases of colorectal cancer occur frequently, but only 10,20% are eligible for liver surgery. Recent new developments changed the concepts of treating patients with colorectal liver metastases. Aim To describe the available modalities that can result in increasing resectability rate. Methods Potentials and drawbacks of portal vein embolization, radiofrequency ablation (RFA), trans-ablated tumour hepatectomy, neoadjuvant chemotherapy and the approach to patients with extrahepatic metastases are described. Results Portal vein embolization is a well-established technique to increase the volume of the future liver remnant. RFA should be applied if partial liver resection alone cannot make the liver tumour-free. Neoadjuvant chemotherapy in patients with unresectable liver metastases can result in secondary resectability rates of 15,40%. Hepatotoxicity can lead to a higher complication rate after partial liver resection. A limited number of extrahepatic tumour localizations should be resected as well. Conclusions A more aggressive approach to patients with colorectal liver metastases improves resectability rate and survival. Unfortunately, these new options have not been thoroughly evaluated in randomized controlled trials. For some of these modalities, the currently available results are so promising that it might be difficult to start such trials in the future. [source] Liver-targeted doxorubicin: effects on rat regenerating hepatocytesLIVER INTERNATIONAL, Issue 3 2004Giuseppina Di Stefano Abstract: Background/Aims: The conjugate of doxorubicin (DOXO) with lactosaminated human albumin (L-HSA) has the potential of improving DOXO efficacy in the treatment of hepatocellular carcinomas (HCCs) expressing the asialoglycoprotein receptor (ASGP-R). In view of an adjuvant chemotherapy with L-HSA,DOXO after the surgical removal of the tumour, in the present experiments we verified whether DOXO accumulation produced by the conjugate can impair the liver regeneration following hepatic resection in non-cirrhotic liver. Methods: Using saline-injected hepatectomised rats as controls, we studied the effects of the conjugate on the ultrastructure of regenerating hepatocytes and evaluated [3H]thymidine incorporation, mitotic index and rate of DNA recovery in the liver remnant. Results: L-HSA,DOXO caused a selective drug accumulation in liver remnant, with low DOXO levels in extra-hepatic tissues. It did not change the ultrastructure of hepatocytes and did not increase serum alanine aminotransferase. It decreased [3H]thymidine incorporation and mitotic index, causing a moderate delay in hepatic DNA recovery. Conclusions: The experiments indicate a substantial resistance of rat regenerating hepatocytes to high intracellular concentrations of DOXO. They support the possibility of using L-HSA,DOXO in an adjuvant chemotherapy after the surgical removal of HCCs which maintain the ASGP-R. [source] Hepatic Resection in Liver Transplant Recipients: Single Center Experience and Review of the LiteratureAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2005Olaf Guckelberger Biliary complications such as ischemic (type) biliary lesions frequently develop following liver transplantation, requiring costly medical and endoscopic treatment. If conservative approaches fail, re-transplantation is most often an inevitable sequel. Because of an increasing donor organ shortage and unfavorable outcomes in hepatic re-transplantation, efforts to prolong graft survival become of particular interest. From a series of 1685 liver transplants, we herein report on three patients who underwent partial hepatic graft resection for (ischemic type) biliary lesions. In all cases, left hepatectomy (Couinaud's segments II, III and IV) was performed without Pringle maneuver or mobilization of the right liver. All patients fully recovered postoperatively, but biliary leakage required surgical revision twice in one patient. At last follow-up, two patients presented alive and well. The other patient with persistent hepatic artery thrombosis (HAT), however, demonstrated progression of disease in the right liver remnant and required re-transplantation 13 months after hepatic graft resection. Including our own patients, review of the literature identified 24 adult patients who underwent hepatic graft resection. In conclusion, partial graft hepatectomy can be considered a safe and beneficial procedure in selected liver transplant recipients with anatomical limited biliary injury, thereby, preserving scarce donor organs. [source] Liver failure following partial hepatectomyHPB, Issue 3 2006Thomas S. Helling Abstract While major liver resections have become increasingly safe due to better understanding of anatomy and refinement of operative techniques, liver failure following partial hepatectomy still occurs from time to time and remains incompletely understood. Observationally, certain high-risk circumstances exist, namely, massive resection with small liver remnants, preexisting liver disease, and advancing age, where liver failure is more likely to happen. Upon review of available clinical and experimental studies, an interplay of factors such as impaired regeneration, oxidative stress, preferential triggering of apoptotic pathways, decreased oxygen availability, heightened energy-dependent metabolic demands, and energy-consuming inflammatory stimuli work to produce failing hepatocellular functions. [source] Surgical resection of primary and metastatic hepatic malignancies following portal vein embolizationJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2009Brian Mailey MD Abstract Background Portal vein embolization (PVE) has been used to induce hypertrophy in future liver remnants (FLRs) in preparation for major hepatic resection. We report our initial experience with PVE and identify potential predictors of unresectability following PVE. Methods Patients with primary and metastatic hepatic malignancies (n,=,20) who underwent PVE between 2004 and 2008 were categorized by surgical resection status and clinicopathologic factors were compared. Results The cohort had the following histologies: colorectal adenocarcinoma (45%, n,=,9), hepatocellular carcinoma (20%), cholangiocarcinoma (20%), and other (15%). Seven patients (35%) had previous liver-directed or regional therapy; 55% subsequently underwent successful liver resection, whereas 45% were deemed unresectable. Patients who underwent successful resection had tumor shrinkage after PVE compared to unresectable patients (% change in maximal tumor diameter, ,6% vs. +45%, respectively; P,=,0.027) and had a lower rate of baseline liver function test abnormality (0% vs. 56%, respectively; P,=,0.004). Resected patients had an 83% 5-year overall survival. Conclusions Baseline liver dysfunction may predict subsequent unresectable hepatic disease following PVE and tumor progression after PVE appears to increase the likelihood for finding unresectable hepatic disease. Select patients should be considered for PVE with careful surveillance during the period of FLR hypertrophy. J. Surg. Oncol. 2009;100:184,190. © 2009 Wiley-Liss, Inc. [source] | ||||||||||