HCC : O-015 ; The prognostic significance of the worst grade in hepatocellular carcinoma with mixed histologic grades

( Dai Hoon Han ),( Gi Hong Choi ),( Kyung Sik Kim ),( Jin Sub Choi ),( Young Nyun Park ),( Seung Up Kim ),( Jun Yong Park ),( Sang Hoon Ahn ),( Kwang Hyub Han ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Backgrounds & Aims: The tumor differentiation has been known to one of the prognostic factors after the treatment of hepatocellular carcinoma (HCC). According to the 7th edition of the AJCC cancer staging manual, the grading scheme of Edmondson and Steiner (ES) is recommended. In HCC, multistep carcinogenesis frequently leads to mixed histologic grades. However, there has been no study about the prognostic significance of the worst grade in HCC with mixed histologic grades. The current study attempted to reveal which determines the prognosis after resection, the major or the worst grade in mixed histologic types. Materials & methods: From January 1996 to March 2010, a total of 724 patients underwent curative resection of HCC at Yonsei University Health System, Korea. Among them, 99 who had total necrosis due to previous treatment were excluded. Six hundred and twenty-five patients were first classified into homogenous and mixed grades. HCC with homogenous grade was further divided into three groups: HG1 (ES I, n=16), HG2 (ES II, n=241) and HG3 (ES III, n=156). Mixed histologic group was classified into M1 (n=52) and M2 (n=142) which had the worst histologic grade ES II and ES III, respectively. Disease-free survival (DFS) and overall survival (OVS) in each group were analyzed, and clinicopathologic features between each group were compared. Results: 5-year DFS and OVS in each group were as follows: HG1 is 52.8% and 87.5%, M1 is 52.5% and 83.2%, HG2 is 52.2% and 71.4%, M2 is 43.5% and 55.1%, HG3 is 38.5% and 52.8, respectively. No statistically significant difference in survival was observed among HG1, M1, and HG2. However, the rates of DFS and OVS were significantly lower in M2 compared with HG2 (p=0.004 and 0.025, respectively) whereas DFS and OVS of M2 were not significantly different from HG3. There were no significant differences in the clinicopathological features of HG2, M2 and HG3 except that microvascular invasion was more frequently observed in M2 than HG2. In multivariate analysis, more advanced histologic group (M2 and HG3) was one of independent poor prognostic factors for DFS and OVS after curative resection. (p=0.028 and <0.001; relative risk, 1.367 and 1.769, respectively) Conclusions: In this study, HCC with the worst grade ES III showed similar clinicopathologic characteristics and prognosis compared with HCC with homogenous ES III. Therefore, in patients with advanced histologic grade (≥ ES II), the worst histologic grade may determine the prognosis after curative resection of HCC.

Robot versus Laparoscopic Anatomic Liver Resection: Comparison Study for Feasibility

( Dai Hoon Han ),( Sung Whan Cha ),( Gi Hong Choi ),( Jin Sub Choi ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Minimally invasive anatomic liver resection (MIALR) is still considered as challenging procedures for liver surgeons. This study aimed to analyze the feasibility of laparoscopic and robotic system in the single surgeon from the beginning of experience. Methods: From August 2008 to December 2016, 119 consecutive patients underwent anatomical minimally invasive liver resection by the single surgeon in Severance hospital, Seoul, Korea. In terms of anatomic live resection, left lateral sectionectomy was exclueded in this study. Fifty-five and sixty-four patients got laparoscopic liver resection (LLR) and robotic liver resection(RLR) respectively. Main causes of liver resection were hepatocellular carcinoma in both groups (40 (72.7%) Vs 42 (65.6%)). Baseline characteristics (gender, body mass index, liver cirrhosis on histopathology, and preoperative laboratory findings) and operative outcomes (operation time, amount of bleeding, complication, right side or left side approach and conversion to open procedure) were compared between two groups. Moreover, conversion rate and approach direction was compared by time periods. Results: Baseline characteristics were not different in both groups. However, conversion rates were significantly higher in LLR group (12 (21.8%) Vs 5 (7.8%), p-value = 0.029). Operative time was significantly longer in RLR group (498.66 ± 193.33 Vs 287.31 ± 85.4, p-value<0.001). MIALR were more frequently accomplished by robotic system until 2012 (8 (22.2%) Vs 28 (77.8%), p-value = 0.001). Conclusions: RLRs had lower conversion rate than LLRs. Moreover, MIALR were more frequently accomplished by robotic system in the early period. Thus, RLR may allow the surgeon to successfully accomplish the MIALR.

HCC : Comparison of Surgical Outcome between Minimally Invasive Liver Resection and Conventional Open Liver Resection for the Treatment of Hepatocellular Carcinoma: A Propensity-score Matched Analysis

( Dai Hoon Han ),( Eun Jung Park ),( Gi Hong Choi ),( Jin Sub Choi ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: This study aimed to analyze operative and survival outcomes of minimally invasive liver resection (MILR) versus conventional open liver resection (COLR) for the treatment of hepatocellular carcinoma (HCC). Moreover, we attempted to reveal the role of the robotic system in MILR (HCC). Materials and methods: From January 1996 to December 2012, 1014 consecutive patients underwent curative liver resection of HCC. Among these patients, 90 patients with MILR were matched to 360 patients with COLR by one-to-four propensity- score matched analysis. A multivariable logistic model based on age, gender, etiology of HCC, tumor size, multiplicity of tumor, the presence or absence of liver cirrhosis and extent of liver resection was used to estimate propensity score. Perioperative surgical outcomes and long-term survival were compared between two groups. Results: The amount of blood loss during operation, transfusion rate and postoperative complication rate were significantly lower in MILR groups. Mean length of hospital stay after operation was significantly shorter in MILR group (8.57 vs. 13.44 days, P<0.001). There were 7 cases of open conversion from MILR and all cases were laparoscopic attempted liver resections. In MILR group, most of major resections were performed with robotic system (n=10, P<0.001). Anatomic liver resections were performed for 15 of 16 patients using robotic system. There was no difference in primary recur site between two groups. The 1-, 2-, 3-year disease-free survival rate of MILR were 84.7%, 66.8%, and 59.6 % respectively, which were comparable to those of COLR (P =0.579). Conclusions: MILR showed better perioperative outcomes with comparable oncologic outcomes for the treatment of HCC. According to the complexity of procedures, the robotic surgery may expand the indication of minimally invasive liver resection in patients with HCC.

What Kind of Energy Device Do You Choose during Laparoscopic Liver Resection

Dai Hoon Han 대한외과학회 2021 대한외과학회 학술대회 초록집 Vol.2021 No.11

Reasons for ICU Admission after Hepatectomy and Matters of Debate Between Surgeon and Surgical Intensivist

Dai Hoon Han 대한외과학회 2021 대한외과학회 학술대회 초록집 Vol.2021 No.11

책임지도전문의 Burnout 실태조사

Dai Hoon Han 대한외과학회 2021 대한외과학회 학술대회 초록집 Vol.2021 No.11

Technique of Intraoperative Ultrasound for Laparoscopic Hepatectomy

Dai Hoon Han 대한외과학회 2019 대한외과학회 학술대회 초록집 Vol.2019 No.10

Current status of robotic surgery for liver transplantation

Dai Hoon Han 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.2

Successfully performing laparoscopic procedures in donor hepatectomy provides better quality of life and minimizes surgical complications for the donor. However, only a few experienced institutions can perform laparoscopic donor hepatectomy, which has a long learning curve and unergonomic surgical conditions. Meanwhile, robotic surgical systems have advanced to the point that they can compensate for the limitations of laparoscopic surgical systems. A robotic system provides a steady and magnified three-dimensional visualization with a wide range of motion and tremor-free instrumentation. Due to the benefits of robotic systems, robotic donor hepatectomy has been successfully performed in recent years. Therefore, the aim of this review is to present the current circumstances regarding the use of robotic systems in liver transplantation.

Anatomical Liver Resection

( Dai Hoon Han ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Fluorescence imaging using indocyanine green (ICG) had been used clinically to visulalize the vascular as well as lymphatic anatomy in realtime during surgery. This technique also has been utilizing for anatomical liver resection not only for conventional open surgery but also for minimally invasive liver resection. The fluorescent property of ICG as well as its biliary excretion property can be used for anatomical liver resection. Since approval of ICG by Food and Drug Administration (FDA) in 1954, ICG has been used mainly to evaluate the liver function in the field of liver surgery. The fluorescence property of ICG was characterized in detail in the 1970s. Protein-bound ICG emits fluorescence that peaks at about 840 nm when illuminated with near-infrared light between 750 and 810 nm. Near-infrared (NIR) fluorescent light has several advantageous properties for intraoperative imaging. The wavelength of NIR light is between 700 and 900 nm, which is invisible to the naked human eye, and therefore does not alter the look of the surgical field. In the meantime, anatomical liver resection is essential surgical technique for liver surgeon. Especially for the treatment of hepatocellular carcinoma, anatomical liver resection might reduce the intrahepatic metastases comparing with non-anatomical resection. Bleeding during operation also might be reduced under anatomical liver resection. Moreover, there were lack of ischemic area in the remnant liver which may be the source of postoperative complication. However, it is quite difficult to distinguish the exact anatomical dissection plane through the liver which is invisible solid organ. Although various surgical technique such as ischemic demarcation line after blocking of inflow blood flow of future-resected liver, injection of dye such as methylene blue into the portal pedicle, determination of anatomical plane according to intraoperative ultrasonography, and preoperative 3 dimensional reconstruction of hepatic vasculature were adapted to perform the exact anatomical liver resection, the performance of each technique had some limitations. Mapping with vital blue dyes under intraoperative ultrasound can sometimes yield indistinct results, and it is much more difficult to reproduce in laparoscopic procedure. Ischemic demarcation also indistinguishable especially in the liver with jaundice or covered by connective tissue from adhesion. Liver dome area is also somewhat difficult to distinguish the ischemic demarcation line. In the contrary, ICG fluorescence technique may be useful to find out the exact anatomical dissection line. It is easy to apply. Demarcation line is clear. Anatomical plane may be identified during parenchymal dissection. Moreover, adaptation to minimally invasive liver resection seems to be convenient. Therefore, ICG fluorescence technique may be useful for anatomical liver resection.

[Free Paper] Robotic left hepatectomy and choledocholithotomy for the patient with Intrahepatic and common bile duct stones

Dai Hoon Han,Gi Hong Choi,Sung Hoon Choi,Sung Hoon Kim,Jin Sub Choi,Woo Jung Lee 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11