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( Jinsoo Rhu ),( Jong Man Kim ),( Gyu Seong Choi ),( Choon Hyuck David Kwon ),( Jae-won Joh ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: This study was designed to analyze factors related to the success of salvage liver transplantation in hepatocellular carcinoma (HCC). While liver resection is considered the best locoregional therapy in HCC, there is a high recurrence rate. Salvage liver transplantation may be the best treatment option when feasible. Methods: Patients who underwent living donor salvage liver transplantation for recurrent HCC after LR from November 1996 to May 2017 were included. Patient demographic data, clinical and pathologic characteristics, operative data, hospital course and follow-up data regarding initial liver resection, locoregional therapy after recurrence and salvage liver transplantation were reviewed. Prognostic factors for recurrence were analyzed using Cox proportional hazard ratio. Results: Eighty-five of 123 salvage liver transplantation patients were included. Patients who had five or more locoregional therapies prior to salvage liver transplantation (HR=3.74, CI=1.45- 9.64, P=0.006), hepatitis B (HR=9.20, CI=1.13-74.89, P=0.04), outside Milan criteria at the time of salvage liver transplantation (HR=2.66, CI=1.26-5.63, P=0.011) and an alpha-fetoprotein level above 1,000 ng/mL at the time of recurrence after initial liver resection (HR=6.48, CI=1.83-22.92, P=0.004) and at the time of transplantation (HR=3.43, CI=1.26-5.63, P=0.011) were related to significant risk of recurrence. Conclusions: Continuing five or more locoregional therapies for recurrent HCC after liver resection is related to poor recurrence-free survival after salvage liver transplantation.
Jinsoo Rhu,임소영,Danbee Kang,Juhee Cho,Heesuk Lee,Gyu-Seong Choi,Jong Man Kim,Jae-Won Joh 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.3
Three-dimensional (3D) modeling of the liver can be especially useful for both the surgeon and patient to understand the actual location of the tumor and planning the resection plane. Virtual reality (VR) can enhance the understanding of 3D structures and create an environment where the user can focus on contents provided. In the present study, a VR platform was developed using Unreal Engine 4 software (Epic Games, Potomac, MD, USA). Patient’s liver based on magnetic resonance image was imported as a 3D model that could distinguish liver parenchyma, vascular structure, and cancer. Preoperative education videos for patients were developed. They could be viewed inside the VR platform. To evaluate the usefulness of VR education program for patients undergoing liver resection for hepatocellular carcinoma, a randomized clinical trial evaluating the knowledge and anxiety of the patient was designed. The case presented in this report was the first experience of performing the VR education program and examining the knowledge and anxiety using questionnaires. When the knowledge score increased, the anxiety score also increased after the education program. Based on findings of this pilot case study, the timing and place where the questionnaire will be answered can be modified for formal initiation of the randomized controlled study to examine the usefulness of VR in patient education.
( Jinsoo Rhu ),( Gyu Seong Choi ),( Jong Man Kim ),( Jae-won Joh ),( Choon Hyuck David Kwon ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: We designed this study to analyze the feasibility of laparoscopic living donor hepatectomy compared to open living donor hepatectomy. Methods: Donors who underwent living donor right hemihepatectomy or extended right hemihepatectomy by laparoscopy or open surgery from May 2013 to October 2017 were included in the study. Comparisons between laparoscopic surgery and open surgery were performed using Student’s t-test, Mann-Whitney test, chi-square test, Fisher’s exact test, and linear-by-linear association. Results: During the study period 305 patients underwent living donor right hemihepatectomy or extended right hemihepatectomy. Of these, 100 underwent laparoscopic surgery and 205 underwent open surgery. The laparoscopy group (30.9±11.2 years) had significantly younger age than the open group (34.5±12.3 years, P=0.014). The laparoscopy group mostly had type 1 (95.0%) bile duct and 81% had single bile duct in liver grafts, compared with 59.5% type 1 bile duct and 59.5% with single bile duct in the open group. The laparoscopy group had significantly longer operation time (378.2 ± 93.5 minutes vs. 329.1 ± 68.0 minutes, P<0.001) and warm ischemic time (median 271 minutes vs. 151 minutes, P<0.001) compared to the open group. However, estimated blood loss was smaller in the laparoscopy group (298.3 ± 162.9 mL vs. 344.3 ± 149.9 mL, P=0.015). There was no difference in complication rate (lap-aroscopy group 22.0% vs. open group 15.6%, P=0.170) and the severity of complications classified by Clavien-Dindo system did not differ significantly between the groups (P=0.094). Conclusions: When living donors are selected cautiously, lap-aroscopic living donor hepatectomy can be performed safely with similar outcome to open surgery. However, the procedure should be performed by a surgeon experienced in both liver transplantation and minimally invasive surgery.
Jinsoo Rhu,Mi Seung Kim,Sangjin Kim,Gyu-Seong Choi,Jong Man Kim,Jae-Won Joh 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2
While 3D printing is adapted usefully in certain field of surgery, its application in liver surgery was limited. Here, we introduce our experience for using 3D printing for intraoperative guidance during liver resection in a case for HCC with an intrahepatic metastasis at a sophisticated location. A 50 years old male patient was diagnosed 4.7 cm-sized hepatocellular carcinoma located on segment 3 with and an intrahepatic metastasis located on segment 8 which was between right anterior portal vein, middle hepatic vein and right hepatic vein. Since radiofrequency ablation appeared to be inappropriate, surgical resection was planned. However, the patient had a cirrhotic liver and left liver was estimated to be 47% according to volume measurement. Therefore, we planned a two-step procedure by performing left hemihepatectomy preserving the middle hepatic vein and additionally removing the intrahepatic metastasis by tumorectomy. For better guidance, we made a 3D printed model tailored for using it as a guidance during operation, and the accuracy of 3D-printed model helped the surgical team perform a safe operation. The patient underwent adjuvant proton beam therapy on the site of tumorectomy and did not experience recurrence.