Repeat hepatectomy for recurred colorectal liver metastasis: is it justified?

Jangho Park,Seung-Duk Lee,Sung-Sik Han,Seoung Hoon Kim,Sang-Jae Park,Jae Hwan Oh,Jungnam Joo 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.97 No.1

Purpose: Liver resection is considered the only curative treatment modality for colorectal liver metastasis. The recurrence rate after hepatectomy is >50%. Two or more hepatectomies are applied to treat recurred metastases. We assessed the efficiency and feasibility of repeat hepatectomy and analyzed the prognostic factors after a repeat hepatectomy. Methods: In total, 248 patients were diagnosed with recurred liver metastasis between January 2003 and May 2016. Second and third hepatectomies were performed in 70 and 7 patients, respectively. The other 171 patients did not undergo a repeat hepatectomy. Clinical features were collected from the medical records. We analyzed survival rates of the repeat hepatectomy group and the nonrepeat hepatectomy group. We also investigated factors affecting overall and disease-free survival of patients who received a repeat hepatectomy using univariate and multivariate analyses. Results: Median overall survival was significantly higher in the repeat hepatectomy group than in the nonrepeat group (83.0 months vs. 25.0 months, P < 0.001). The morbidity and mortality rates of repeat hepatectomy were 9.1% and 0%, respectively. Median overall and disease-free survival of the repeat hepatectomy group were 62.0 and 51.0 months, respectively. The number of recurred tumors was the only significant factor for disease-free survival (P = 0.029). None of the factors affected overall survival. Conclusion: Repeat hepatectomy is necessary, effective, and safe for treating recurred colorectal liver metastasis. Repeat hepatectomy can be considered in patients with fewer than three recurred metastatic tumors

ERAS in minimally invasive hepatectomy

Andrew K. Y. Fung,Charing C. N. Chong,Paul B. S. Lai 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.2

Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.

Effects of Splanchnic Vasoactive Agents on Hepatic Functional Recovery and Regeneration in Porcine 70% Partial Hepatectomy Model

( Dong-sik Kim ),( Jae Hyun Han ),( Yoonyoung Choi ),( Jaehyung Kim ),( Joo-young Kim ),( Kyung-sook Yang ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Excessive portal pressure is considered as one of the most important factor for development of post-hepatectomy liver failure (PHLF) and small-for-size syndrome (SFSS) after partial liver transplantation. We aimed to determine the effects of splanchnic vasoactive agents such as terlipressin and octreotide on recovery of hepatic function and regeneration using porcine 70% hepatectomy model, for evaluation of potential for clinical use in prevention and treatment of PHLF and SFSS. Methods: Twenty-one pigs were divided into 4 groups; sham operation group (n = 3), control group (n = 6), terlipressin group (n = 6) and octreotide group (n = 6). 18 pigs except sham operation group underwent 70% hepatectomy. Terlipressin (0.5mg, t.i.d.) and octreotide (0.5mg, t.i.d.) were administered via subcutaneous route starting immediately after completion of hepatectomy. Portal pressure was measured at baseline, 0.5, 1, 6 hours and 7 days after hepatectomy. Blood samples were drawn at baseline, 1,6 hours and 7 days after hepatectomy for measurement of aspartate aminotransferase, bilirubin, prothrombin time. Animals were executed on 7th day from initial hepatectomy. 7-day survival rate was calculated and histologic scoring of liver injury was measured. Results: Portal pressure was significantly lower in terlipressin and octreotide group than control group (p = 0.009 and 0.034, respectively). None in octreotide group, one in terlipressin group and two in control group expired before planned termination on 7th day Mean survival time was not significantly different between groups (p = 0.301). Asparate aminotransferase was significantly lower in terlipressin group than control group (p = 0.021) and total bilirubin was also lower in terlipressin group than control group with borderline significance (p = 0.083). Liver regeneration rate was significantly lower in terlipressin group than control group (p = 0.032). Histologic scoring focusing on inflammatory change was decreased in both treated groups than control group (terlipressin group; p = 0.014, octreotide group; p = 0.056). Conclusions: Splanchnic vasoactive agents, especially terlipressin decreased portal pressure and showed better clinical features despite of lower liver regeneration rate after liver resection. It indicates that these drugs may play an important role in prevention and treatment of PHLF and SFSS maintaining a balance between liver regeneration and functional recovery.

Portal Vein Thrombosis after Hepatectomy

( Akmaral Dossanova ),( Lazzat Dossanova ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: This study evaluated the incidence, risk factors, and clinical outcomes of PVT after hepatectomy. Methods: The preoperative and postoperative clinical characteristics of patients who underwent hepatectomy were retrospectively analyzed. A total of 208 patients were reviewed. The incidence of PVT after hepatectomy was 9.1% (n=19), includeing main portal vein (MPV) thrombosis (n=7) and peripheral portal vein (PPV) thrombosis (n=12). Patients with MPV thrombosis had a significantly higher incidence of right hepatectomy (P<0.001), larger resection volume (P=0.003), and longer operation time (P=0.021) than patients without PVT (n=189) Results: Multivariate analysis identified right hepatectomy as a significant independent risk factor for MPV thrombosis (odds ratio 108.9; P<0.001). Patients with PPV thrombosis had a significantly longer duration of Pringle maneuver than patients without PVT (P=0.002). Among patients who underwent right hepatectomy, those with PVT (n=6) had a significantly lower early liver regeneration rate than those without PVT (n=13; P=0.040), and those with PVT had deterioration of liver function on postoperative day 7. In all patients with MPV thrombosis who received anticoagulation therapy, PVT subsequently resolved. Conclusions: Postoperative PVT after hepatectomy is not rare. It is closely related to delayed recovery of liver function and delayed liver regeneration.

Oncologic Outcome after 2 Stage Hepatectomy - Experience of Single Institution

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

Aims: To evaluate the oncologic outcome after 2 stage hepatectomy for colorectal liver metastasis. Methods: From January 2010 to December 2016, 23 patients who underwent 2 stage hepatectomy for colorectal liver metastasis were enrolled. Perioperative outcome and oncologic outcome were reviewed retrospectively. Results: Median interval between 1st hepatectomy and 2nd hepatectomy was 27.9±12.1 days, and postoperative hospital stay after 2nd hepatectomy was 16±9.25 days. Complication after 2nd hepatectomy was reported in grade II 7 cases, grade III 5 cases and grade V 1 case. For portal vein ligation, percutaneous portal vein embolization was done in 12 patients, intraoperatively selective portal vein ligation was done in 5 patients and ALPPS was done in 6 patients. Median disease free survival and overall survival were reported 5.25 months and 32.25 months respectively. 14 patients had early recurrence less then 6 months after 2nd hepatectomy. Conclusions: 2 stage hepatectomy can be performed safely and aslo can give chance for long-term survival for colorectal liver metastasis. Further study is required for prognostic factor for recurrence as there is high possibility of early recurrence

Splenectomy affects the balance between hepatic growth factor and transforming growth factor-β and its effect on liver regeneration is dependent on the amount of liver resection in rats

Joohyun Kim,Chang-Ju Kim,Il-Gyu Ko,Sun Hyung Joo,Hyung Joon Ahn 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.4

Purpose: Small-for-size syndrome (SFSS) is a major problem in liver surgery, and splenectomy has been used to prevent SFSS. However, it is unknown whether splenectomy has the same effect on liver regeneration in both standard and marginal hepatectomy. The aim of this study is to see a difference in effect of splenectomy on liver regeneration according to the amount of liver resection. Methods: Thirty male Sprague-Dawley rats (220 to 260 g) were divided into the following five groups: control (n = 6), 70% hepatectomy (n = 6), 70% hepatectomy with splenectomy (n = 6), 90% hepatectomy (n = 6), and 90% hepatectomy with splenectomy (n = 6). The animals were euthanized 24 hours after surgery and liver specimens were obtained. To assess liver regeneration, we performed immunohistochemistry of liver tissue using 5-bromo-2-deoxyuridine (BrdU) labeling and Western blot analysis of hepatic growth factor (HGF) and transforming growth factor-β (TGF-β) in the liver tissue. Results: The splenectomized subgroup had a higher BrdU-positive cell count in the 90% hepatectomy group, but not in the 70% hepatectomy group (P < 0.001). Splenectomy significantly decreased TGF-β expression (P = 0.005) and increased the HGF to TGF-β ratio (P = 0.002) in the 90% hepatectomy group, but not in the 70% hepatectomy group. Conclusion: The positive effect of splenectomy on liver regeneration was greater in the group with the larger liver resection. This phenomenon may be related to the relative balance between HGF and TGF-β in the liver.

좌측 간내 결석 환자에서 복강경 간절제의 유용성

송유정(Yu-jeong Song),김가정(Ka-Jeong Kim),문형곤(Hyung-Gon Moon),정상호(Sang-Ho Jeong),주영태(Young-Tae Ju),정은정(Eun-Jung Jung),이영준(Young-Joon Lee),홍순찬(Soon-Chan Hong),최상경(Sang-Kyung Choi),하우송(Woo-Song Ha),박순태(Soon- 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1

Purpose: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. Methods: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. Results: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. Conclusion: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

The Combined Effect of Stem Cell Factor and Granulocyte Macrophage Colony-stimulating Factor Administration after 90% Partial Hepatectomy in Rats

( Seung Duk Lee ),( Hyeong Min Park ),( Dasom Choi ),( Hyerim Byeon ),( Seong Hoon Kim ),( Young-kyu Kim ),( Sung-sik Han ),( Sang-jae Park ),( Eun Kyung Hong ),( Nam-joon Yi ),( Jin-young Jang ),( Ju 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The purpose of this study was to identify the impact of exogenous SCF and GM-CSF administration after 90% major hepatectomy in rats. Methods: Sprague Dawley rats underwent 90% major hepatectomy using a bile duct-sparing portal pedicle ligation technique under microscopy. The rats were divided into two groups: group 1 (phosphate-buffered saline) and group 2 (SCF+GM-CSF treatment, each 25 mcg/kg). Treatment was administrated immediately after operation through the inferior vena cava. Liver regeneration capacity and expression of cytokines and their downstream signaling molecules were evaluated at postoperative day 1, 2, 4, and 7. Results: The survival rate after 90% hepatectomy in rats using this technique were increased to 95% compared with 55% with conventional parenchymal ligation technique (p = 0.004). The combination effect of SCF and GM-CSF was evaluated in in vitro study. Group 2 exhibited a significantly increased liver regeneration index at early period after hepatectomy compared to group 1 (day 2: 287.5 ± 19.6 vs. 513.9 ± 67.1, p = 0.025 and day 4: 647.6 ± 108.8 vs. 941.7 ± 53.9, p = 0.046). Furthermore, serum liver enzyme levels including total bilirubin, aspartate aminotransferase, and alanine aminotransferase, were significantly lower in group 2 than in group 1 on postoperative days. The expression of Ki-67 and cyclin D1 were significantly higher in group 2 than in group 1 on postoperative days. Group 2 displayed significant increases of interleukin (IL)-6 and transforming growth factor (TGF)-β expression within 24 h after hepatectomy. Especially, C-X-C motif chemokine 12 (CXCL12)/C-X-C chemokine receptor type 4 (CXCR4) and matrix metalloproteinases 2 and 9 levels in the liver tissue of group 2 were also significantly upregulated according to quantitative polymerase chain reaction on postoperative days. Conclusions: Our data suggest that the administration of SCF+GM-CSF after major hepatectomy can enhance liver regeneration by liver cell proliferation and mobilization of stem cell modulating IL-6/TGF- β and CXCL12/CXCR4 pathway as well as by matrix remodeling. These findings suggest the possibility of therapeutic treatment using a combination of SCF and GM-CSF in the clinical setting to promote liver regeneration after extreme hepatectomy.

좌측 간내 결석 환자에서 복강경 간절제의 유용성

김주연(Ju yeon Kim),문형곤(Hyoung gon Moon),정상호(Sang ho Jeong),주영태(Young tae Ju),정은정(Eun joung Jung),이영준(Young joon Lee),홍순찬(Soon chan Hong),최상경(Sang Kyung Choi),박순태,하우송(Woo song Ha),정치영(Chi young Jeong) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.3

Purpose : Recently, there have been several studies on the early results on the use of hepatectomy for the treatment of a variety of hepatic lesions. We report the early experience of our hospital after totally laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. Methods : We analyzed the medical records of patients on a retrospective bases, who had been diagonsed with left intrahepatic stones and had undergone an hepatectomy between January 2008 and June 2009. Patients were grouped according to their operative procedure into one of the following: open hepatectomy, laparoscopy-assisted hepatectomy, and totally laparoscopic hepatectomy. Results : There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during the time period under study. Hepatectomy with open method, laparoscopy-assisted method, and totally laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the 3 methods for operating time and postoperative complications. However, the number of fasting times and hospital days was shorter with performing total laparoscopic hepatectomy than in other occasions. Conclusion : Totally laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

A cohort study on the risk of hepatectomy and pancreatectomy after history of abdominal surgery on other organs

Atsushi Nanashima,Masahide Hiyoshi,Naoya Imamura,Koichi Yano,Takeomi Hamada,Takashi Wada,Takahiro Nishida,Kazuyo Tsuchiya,Fumiaki Kawano,Shinsuke Takeno,Takuto Ikeda 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.4

Backgrounds/Aims: The present study analyzed the postoperative outcomes in patients who underwent hepatectomy or pancreatectomy, with a history of intra-abdominal surgery involving other organs, to elucidate surgical efficacy. Methods: We examined the perioperative parameters in 28 patients who underwent hepatectomy (n=12) and pancreatectomy (n=16) after receiving prior abdominal organ resection (esophagectomy, n=2; gastrectomy, n=5; resection of small intestine, n=2; appendectomy, n=5; colorectal resection, n=9; hepatectomy, n=1; cholecystectomy, n=3; splenectomy, n=2, pancreatectomy ,right adrenectomy, nephrectomy and myoma uteri, n=1 each). Results: Age, gender, a history of comorbidities, and primary diseases were not significantly different between the groups. The present operation was predominantly indicated for liver metastases in all patients undergoing hepatectomy. Several diseases were detected in pancreaticoduodenectomy (PD) patients. Laboratory data were not significantly different between groups. Although operating time and blood loss during hepatectomy did not differ significantly between the groups, the operating time was significantly longer in patients undergoing PD compared with distal pancreatectomy (p<0.05). Red cell blood transfusion was most frequently used in patients who underwent major hepatectomy and PD (p<0.05). The prevalence of postoperative complications was not significantly different between groups. Hospital death was not observed and the period of hospital stay did not differ between groups. Conclusions: Carefully scheduled hepatectomy or pancreatectomy is safe even in cases with prior abdominal surgery under the present strategy.