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Jinsoo Rhu,Jong Man Kim,Gyu Seong Choi,Choon Hyuck David Kwon,Jae-Won Joh,Olivier Soubrane 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.5
Purpose: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. Methods: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. Results: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029–0.970; P = 0.048) was the only significant factor. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.
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.
Jinsoo Rhu,Jong Man Kim,Gyu Seong Choi,Choon Hyuck David Kwon,Jae-Won Joh 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.3
Purpose: This study was designed to analyze factors related to the success of salvage liver transplantation (SLT) in hepatocellular carcinoma (HCC). While liver resection (LR) is considered the best locoregional therapy in HCC, there is a high recurrence rate. SLT may be the best treatment option when feasible. Methods: Patients who underwent living donor SLT 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 LR, locoregional therapy after recurrence and SLT were reviewed. Prognostic factors for recurrence were analyzed using Cox proportional hazard ratio. Results: Eighty-five of 123 SLT patients were included. Patients who had five or more locoregional therapies prior to SLT (hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.45–9.64, P = 0.006), hepatitis B (HR, 9.20; 95% CI, 1.13–74.89; P = 0.04), outside Milan criteria at the time of SLT (HR, 2.66, 95% 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 LR (HR, 6.48; 95% CI, 1.83–22.92; P = 0.004) and at the time of transplantation (HR, 3.43; 95% CI, 1.26–5.63; P = 0.011) were related to significant risk of recurrence. Conclusion: Continuing five or more locoregional therapies for recurrent HCC after LR is related to poor recurrence-free survival after SLT.
Jinsoo Rhu,Jin Seok Heo,Seong Ho Choi,Dong Wook Choi,Jong Man Kim,Jae-Won Joh,Choon Hyuck David Kwon 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.5
Purpose: It is believed that blood from the superior mesenteric vein and splenic vein mixes incompletely in the portal vein and maintains a streamline flow influencing its anatomic distribution. Although several experimental studies have demonstrated the existence of streamlining, clinical studies have shown conflicting results. We investigated whether streamlining of portal vein affects the lobar distribution of colorectal liver metastases and estimated its impact on survival. Methods: Data of patients who underwent hepatectomy for colorectal liver metastases were retrospectively collected. The chi-square test was used for analyzing the distribution of metastasis. Cox analysis was used to identify risk factors of survival. Fisher exact test was used for subgroup analysis comparing hepatic recurrence. Results: A total of 410 patients were included. The right-to-left ratio of liver metastases were 2.20:1 in right-sided colon cancer and 1.39:1 in left-sided cancer (P = 0.017). Cox analyses showed that margin < 5 mm (P < 0.001; 95% confidence interval [CI], 1.648–4.884; hazard ratio [HR], 2.837), age ≥ 60 years (P = 0.004; 95% CI, 1.269–3.641; HR, 2.149), N2 status (P < 0.001, 95% CI, 1.598–4.215; HR, 2.595), tumor size ≥ 45 mm (P = 0.014; 95% CI, 1.159–3.758; HR, 2.087) and other metastasis (P = 0.012; 95% CI, 1.250–5.927; HR, 2.722) were risk factors of survival. However, in 70 patients who underwent right hemihepatectomy for solitary metastasis, left-sided colorectal cancer was a risk factor (P = 0.019; 95% CI, 1.293–17.956; HR, 4.818), and was associated with higher recurrence than right-sided cancer (43.1% and 15.8%, respectively, P = 0.049). Conclusion: This study showed significant difference in lobar distribution of liver metastases between right colon cancer and left colorecral cancer. Furthermore, survival of left-sided colorectal cancer was poorer than that of right-sided cancer in patients who underwent right hemihepatectomy for solitary metastasis. These findings can be helpful for clinicians planning treatment strategy.
( 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.