1,721,084 research outputs found
ASO Authors Reflections: Could Robotics, 3D Imaging, and Liver Venous Deprivation Potentially Redefine Surgical Standards for Perihilar Cholangiocarcinoma?
Full text link: Peri-hilar cholangiocarcinoma remains a major challenge in hepatobiliary surgery, where safety of surgical operation and oncological radicality (R0 resection) are primary goals. Traditional open surgery, including major hepatectomy with caudate lobe and bile duct resection plus lymphadenectomy, remains the standard. Recent advances-robotic platforms, 3D imaging, and liver venous deprivation-offer new possibilities: liver venous deprivation ensures sufficient future liver remnant, and robotics provide precise dissection and enhanced visualization. Although costs and the learning curve remain limiting factors, these strategies could safely expand the use of minimally invasive surgery in peri-hilar cholangiocarcinoma. Validation in larger cohorts is required to assess their true potential
Robotic Right Hepatectomy for Peri-Hilar Cholangiocarcinoma after Liver Venous Deprivation
No full textBackground: Recent innovations such as robotic platforms and liver venous deprivation (LVD) have the potential to improve the management and surgical treatment of peri-hilar cholangiocarcinoma (Ph-CCA). Robotic platforms integrate the operative field view with intraoperative ultrasound and preoperative 3D planning. 1-4 LVD is increasingly preferred over portal vein embolization for better liver hypertrophy outcomes in both speed and percentage.5 This video demonstrates the feasibility of fully robotic right hepatectomy with common bile duct resection and reconstruction for Ph-CCA after LVD. Patients: A Bismuth 3a Ph-CCA was diagnosed in a 74-year-old female with jaundice. Preoperatively, the patient underwent 3D volumetry and planning and percutaneous drainage of left biliary ducts. The future remnant liver volume increased from 38 to 53% of total liver volume after LVD. Technique: Four robotic trocars and one laparoscopic port were placed, and the da Vinci Xi system was docked. En-bloc regional lymphadenectomy was performed, followed by isolation of the hepatic pedicle elements. After mobilization of the caudate lobe and section of the distal common bile duct, the en-bloc right hepatectomy was carried out. A single biliodigestive anastomosis was performed on B2-3-4 on an antecolic Roux-&-Y jejunal loop. The operative time was 810 min. The blood loss was 500 mL. The patient was discharged on postoperative day 16. The pathology confirmed pT2b N0 (0/11 nodes) R0r R0b6,7 G2 Ph-CCA. Conclusion: Although this was a very demanding and challenging approach for both the patient and the surgical team, this video demonstrates the feasibility of this management and probably sets the goal for a new standard of care
Robotic Right Anterior Sectionectomy with Extraglissonean Approach for HCC
No full textBackground: Robotic surgery is gaining momentum in liver resection due to its three-dimensional (3D) magnified view and articulated instrumentation.1 However, some criticism has been raised regarding the anatomical "quality" of parenchymal transection planes in the absence of a specific instrument for parenchymal transection usable by the console's surgeon. Major hepatectomy is traditionally required in case of large hepatocellular carcinoma (HCC) (> 5 cm), however, recent data suggest that minor resections may yield similar outcomes when technically feasible and oncologically adequate.2 This video demonstrates a fully robotic anatomical right anterior sectionectomy (RAS) with extraglissonian approach for HCC. Patient and methods: A 6-cm Sg8 nodule with washout, suggestive of HCC, resting on the middle hepatic vein (MHV) and right hepatic vein (RHV), with involvement of the right anterior Glissonian pedicle (RAGP), was diagnosed in a very motivated 85-year-old male patient with excellent physical shape (PS 0) and hepatitis C virus (HCV)-related chronic liver disease. Four robotic trocars and one laparoscopic port for assistance were placed, and the da Vinci Xi system was docked. RAGP was isolated by extraglissonean and transected with a stapler. After marking with US and ICG, parenchymal transection was performed with complete exposure of RHV and MHV. Operative time was 480 min, blood loss was 300 ml, clamping time 3 × 15 min. No complications occurred, and the patient was discharged on postoperative day 6. Pathology confirmed HCC pT1b R0 resection G1. Conclusions: This video confirms the feasibility and safety of fully robotic anatomical right anterior sectionectomy with extraglissonean approach also in elderly patients.3-4
Manuale di chirurgia generale
No full textLe neoplasie delle vie biliari sono un gruppo eterogeneo di patologie che interessano l'albero biliare; nella grande maggioranze dei casi sono tumori epiteliali a differenziazione ghiandolare che originano dall'epitelio di rivestimento delle vie biliari
Role of surgery in the treatment of intrahepatic cholangiocarcinoma
No full textIntrahepatic Cholangiocarcinoma (ICC) is the second most common primary liver cancer, accounting for 10% to 15% of primary hepatic malignancy, and its incidence is increasing in Western Countries. Surgery with curative intent is the only treatment that offers a chance of long-term survival, with a reported 5-year overall survival rate ranging from 17% to 48%. In the most of recent series postoperative mortality is lower than 5% and morbidity varied from 6% to 66%. The macroscopic classification of ICC, proposed by Liver Cancer Study Group of Japan (LCSGJ), reflects different biologic behaviours, pattern of tumor growth and clinicopathological findings. The most important prognostic factors after resection are positive resection margins, lymph-node metastases, tumor size, presence of macrovascular invasion and intrahepatic metastases. Unfortunately, recurrence is still frequent and it is the leading cause of death. The treatment of the recurrence varied according to the location and extension of the disease. Recently, expression of several genes found to be related with the carcinogenesis of ICC. These molecular findings are helpful to differentiate the biological behaviour and will provide evidence for the development of new target therapies
How much remnant is enough in liver resection?
No full textLiver resection represents the first choice of treatment for primary and secondary liver malignancies, offering the patient the best chance of long-term survival. The extensive use of major hepatectomy increases the risk of post-hepatectomy liver failure (PHLF), which is associated with a high frequency of postoperative complications, mortality and increased length of hospital stay.The aim of this review is to investigate the different risk factors related to the occurrence of PHLF and to identify the limits for a safe liver resection in patients with normal liver and injured liver (cirrhosis, cholestasis, steatosis and post-chemotherapy liver injury).A literature search was undertaken in PubMed and related search engines, looking for articles relating to hepatic failure following hepatectomy in normal liver or injured liver.In spite of improvements in surgical and postoperative management, the parameters determining how much liver can be resected are still largely undefined. A number of preoperative, intraoperative and postoperative factors all contribute to the likelihood of liver failure after surgery. The safe limits for liver resection can be estimated from the data of the literature for patients with normal liver and for those with different types of liver injury.Preoperative assessment that includes evaluation of liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. The critical residual liver volume for patients able to predict PHLF is mainly related to the presence of pre-existing liver disease and liver function. Among patients with normal liver, the limit for safe resection ranges from 20 to 30\% future remnant liver of total liver volume. In patients with injured liver (cirrhosis, cholestasis or steatosis), preoperative assessment of the risk of PHLF should include future remnant liver volumetry and accurate liver function evaluation, including different dynamic liver function tests
Intrahepatic and perihilar cholangiocarcinoma: prognostic value of lymph node ratio after surgical resection
No full textSurgical treatment of ductal biliary recurrence of poorly cohesive gastric cancer mimicking primary biliary tract cancer: a case report
No full text: Ductal biliary recurrence of cancers arising in other anatomical districts is a rare event, usually observed in the setting of disseminated disease; hence surgery is rarely a viable option. We present the case of a 56-year-old male who underwent subtotal gastric resection 7 years earlier for a poorly cohesive gastric cancer, presenting with obstructive jaundice. Magnetic resonance imaging and computed tomography scan suggested primary malignant obstruction of the main bile duct. Percutaneous transhepatic biliary drainage was performed to palliate jaundice and obtain biopsies; pathological examination suggested a ductal biliary recurrence of gastric carcinoma. Pancreaticoduodenectomy and bile duct resection were performed. Histology, immunohistochemistry and molecular profiling confirmed that the stenosis represented a gastric cancer metastasis. This is the first case of an isolated ductal biliary recurrence of gastric cancer amenable to surgical resection. This clinical case suggests that biliary obstructions in patients with previous oncological history require biliary biopsies to exclude a recurrent disease
Total Dorsal Pancreatectomy, an Alternative to Total Pancreatectomy: Report of a New Case and Literature Review
No full textBackground: Total dorsal pancreatectomy (TDP) is a conservative pancreatic resection that should be considered in cases of benign or low malignant tumors confined to the dorsal pancreas to preserve the viability of both digestive and biliary tracts, and to avoid the endocrine and metabolic consequences of total pancreatectomy. We report a new case of TDP and provide a literature review of this procedure. Methods: The case reported was a 35-year-old female patient with a solid pseudopapillary tumor. We resected the dorsal segment of the pancreas while preserving the common bile duct, gastroduodenal artery, and pancreaticoduodenal arcades, and the spleen and splenic vessels. The MEDLINE® and Embase® databases were searched for English language studies, case series, or case reports published through August 31, 2017. Results: The postoperative course was uneventful and patient was discharged on postoperative day 11. The patient was alive and in good condition at the 10-year follow-up. To date in English literature, there are only 3 reported cases of TDP, and all cases were patients with intraductal papillary mucinous neoplasia and pancreas divisum. There was no postoperative mortality, and 2 grade B pancreatic fistulas healed 1 month postoperatively. Conclusions: TDP is a feasible and safe operation for benign or low grade malignant pancreatic tumors involving the dorsal pancreas, as an alternative to total pancreatectomy
Totally intrabiliary colorectal liver metastasis mimicking intraductal growth-type cholangiocarcinoma
No full textLetter To The Edito
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