BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reaso...Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.展开更多
In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recover...In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.展开更多
Liver regeneration(LR)following partial hepatectomy(PH)is a unique and complex physiological response that restores hepatic mass and function through tightly orchestrated cellular and molecular events.Traditionally vi...Liver regeneration(LR)following partial hepatectomy(PH)is a unique and complex physiological response that restores hepatic mass and function through tightly orchestrated cellular and molecular events.Traditionally viewed as a proliferation-driven process,LR is now understood to involve both hepatocyte hyperplasia and hypertrophy,triggered primarily by hemodynamic alterations such as increased portal pressure and shear stress.These promote LR through endothelial–hepatocyte communication via activation of Piezo1-a mechanosensitive ion channel highly expressed in vascular endothelial cells.This channel is considered one of the potential upstream activators of molecular cascades including the interleukin(IL)-6/signal transducer and activator of transcription 3,tumour necrosis factor-alpha/nuclear factor-kappa B,Wnt/β-catenin,Hippo/YAP,transforming growth factor-beta,and Notch pathways,which contribute variably to the proliferation,differentiation,or suppression of hepatic cells.Novel insights into the IL-22 and IL-33 signaling axes,bile acid and glutamine metabolism,and the role of intestinal microbiota are also presented as promising emerging targets.This review synthesizes current insights into the interplay between mechanical cues,key signaling pathways,and metabolic reprogramming that govern early regenerative responses.We explore the mechanisms dictating the balance between hyperplasia and hypertrophy,noting that hypertrophy predominates after minor resections,while proliferation is dominant in larger resections.Polyploidization emerges as a significant adaptive mechanism,contributing to hepatocyte survival and tissue remodeling.The importance of ductular reactions,microvascular adjustments,and extracellular matrix dynamics in lobular architecture remodeling is also highlighted.The study explores the occurrence of ductular reactions in both minor and major resections,particularly within the granulation tissue near dissection areas.The paper also examines structural remodeling in regenerated liver tissue,demonstrating ongoing transformations in hepatocyte morphology and sinusoidal architecture even months after PH,and emphasizing that the termination of liver mass regrowth does not equate to the cessation of LR.展开更多
Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which ...Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.展开更多
Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal a...Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisi...BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.展开更多
BACKGROUND Intraoperative determination of resection margin and adequate residual liver parenchyma are the key points of hepatectomy for the treatment of liver tumors.Intraoperative ultrasound and indocyanine green fl...BACKGROUND Intraoperative determination of resection margin and adequate residual liver parenchyma are the key points of hepatectomy for the treatment of liver tumors.Intraoperative ultrasound and indocyanine green fluorescence navigation are the most commonly used methods at present,but the technical barriers limit their promotion.AIM To evaluate the value of the three-dimensional location approach with silk thread(3D-LAST)in precise resection of liver tumors.METHODS From September 2020 to January 2022,8 patients with liver tumors including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,hilar cholangiocar-cinoma,and gastric cancer liver metastasis were included in this study.All patients underwent 3D-LAST in precise resection of liver tumors.RESULTS All patients(8/8,100%)underwent the operation successfully without any complications.During the mean follow-up of 8.7 months,all patients survived without tumor recurrence.CONCLUSION In conclusion,the 3D-LAST is a safe and effective new method for liver intraop-erative navigation,which is practical and easy to promote.Core Tip:The aim of this study is to evaluate the value of the three-dimensional location approach with silk thread(3D-LAST)in precise resection of liver tumors.Eight patients with liver tumors including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,hilar cholangiocarcinoma,and gastric cancer liver metastasis underwent the operation successfully without any complications.During the mean follow-up of 8.7 months,all patients survived without tumor recurrence.In conclusion,the 3D-LAST is a safe and effective new method for liver intraoperative navigation,which is practical and easy to promote.INTRODUCTION Hepatectomy is widely used for the treatment of liver tumors.In recent decades,the concept and practice of hepatectomy have developed from irregular,regular and anatomical to the current precise resection.Necessary assistive technologies have enabled these advances.Intraoperative ultrasound(IOUS)localization and indocyanine green(ICG)fluorescence imaging guidance are two frequently-used approaches for laparoscopic hepatectomy[1,2].IOUS is an invaluable auxiliary means widely accepted in surgery for real-time diagnostic information to determine resection range and navigate the surgical path[3].However,the major limitation of IOUS is the time cost during the procedure for paging the sono-graphers and the difficulty of deciphering two dimensional images[4].ICG is a non-toxic water-soluble fluorophore that reveals fluorescence under the near-infrared spectrum[5].Since liver tissue penetration is limited to 5 to 10 mm,that restricted the visualization of deeper tumors by ICG excitation,thereby interfering with its application in laparoscopic hepatectomy[6].IOUS and ICG navigation require specific technical equipment,making implementation difficult in many centers.And these techniques will significantly increase the operation time.Three-dimensional(3D)visualization involves extracting features and producing volumetric images based on computed tomography(CT)through a computer postprocessing technique.This tool offers a reasonable approach to the clinical decision for the potential to display the complex internal anatomy in an intuitive and stereoscopic manner[7].In the past few decades,applying 3D simulation software for liver volume calculation,virtual simulation surgery,portal hypertension monitor,and surgical navigation has proven to be safe and effective[8].Therefore,we propose a new method to find obvious anatomical markers and calculate the resection range according to 3D positioning before operation.During the operation,the scope of resection was delineated with silk thread,and resection was performed.This is a new practical approach,which we named as 3D location approach with silk thread(3D-LAST).RESULTS During the study period from September 2020 to January 2022,5 patients with hepatocellular carcinoma,1 patient with intrahepatic cholangiocarcinoma,1 patient with hilar cholangiocarcinoma,and 1 patient with gastric cancer liver metastasis were assessed for liver resection.There were 5 males and 3 females.The mean age of these patients was 54.3±10.2 years(34-66 years).Preoperative 3D positioning was conducted and the scope of resection was delineated with a surgical suture successfully performed in all 8 patients without complications.The treatment results of these 8 patients are shown in Table 1.The 90-day operative mortality was zero.Complications worse than Dindo-Clavien IIIa was not observed at a mean follow-up time of 8.7 months(4-16 months),there was no evidence of tumor recurrence or extrahepatic metastasis.At the time of reporting,the patients are all alive and lead normal lives.We take one patient as an example,58-year-old male,who found a liver lesion 10 months after gastric cancer surgery.Enhanced CT showed that the lesion was located in the liver S5,about 1.5 cm in diameter,and considered metastatic lesions.We performed 3D-LAST guided hepatectomy on this patient(Figure 1).Other representative 3D-LAST surgical procedures are shown in Figure 2.展开更多
To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of l...To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of living-donor liver transplantation(LDLT).Despite its ben-efits,LDLT raises substantial concerns regarding donor morbid-ity,as the procedure involves operating on a healthy individual.Complications associated with donor hepatectomy include abdom-inal trauma,chronic wound pain,physical stress,and psycholog-ical burdens[1,2].In light of these challenges,minimally inva-sive approaches,including laparoscopic and robotic donor hepa-tectomy,have been introduced to mitigate risks and enhance re-covery[3].However,the impact of these techniques on male sex-ual function-a critical aspect of donor quality of life-remains underexplored.Several retrospective studies have highlighted sex-ual dysfunction and altered spousal relationships following open donor hepatectomy[4-6].For instance,9%of donors reported a de-crease in sexual activity,and a significant proportion experienced low body image perceptions.展开更多
BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who unde...BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who underwent hepatectomy followed by a combination of sorafenib and camrelizumab,resulting in complete remission(CR)for 5 years.CASE SUMMARY A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC,Barcelona Clinic Liver Cancer stage C.Enhanced computed tomography imaging revealed a 152 mm×171 mm tumor in the right liver,invading the portal vein and hepatic vein.Liver function was normal.The patient successfully underwent hepatectomy on July 18,2019.However,by December 2019,HCC recurrence with lung metastases and portal vein invasion were detected.He started treatment with sorafenib(200 mg twice daily)and camrelizumab(200 mg every 3 weeks).By May 12,2020,the patient was confirmed to have CR.Camrelizumab was adjusted to 200 mg every 12 weeks from June 16,2021,with the last infusion on March 29,2024.Although no further tumor recurrence was observed,he experienced two episodes of gastrointestinal bleeding due to esophagogastric varices,which were managed with endoscopic therapy.To date,the patient has remained in CR for 5 years.CONCLUSION The combination of hepatectomy with sorafenib and camrelizumab can achieve durable CR in patients with supergiant HCC and portal vein invasion.Further research is necessary to address these challenges and improve patient outcomes.展开更多
BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for lap...BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).展开更多
BACKGROUND Post-hepatectomy liver failure(PHLF),represents a serious complication after liver resection,significantly impacting the long-term outcomes for patients who undergo such surgeries.There exists a strong corr...BACKGROUND Post-hepatectomy liver failure(PHLF),represents a serious complication after liver resection,significantly impacting the long-term outcomes for patients who undergo such surgeries.There exists a strong correlation between intraoperative hemorrhage and transfusion requirements with the development of PHLF.Presently,a combination of hepatic portal occlusion techniques alongside con-trolled low central venous pressure(CLCVP)methodologies is extensively em-ployed to mitigate intraoperative bleeding.Nonetheless,limited studies have analyzed the risk factors for PHLF under CLCVP.AIM To develop and validate a nomogram that predicts the risk factors associated with the development of PHLF patients undergoing liver resection with CLCVP.METHODS We conducted a retrospective analysis of 285 patients who underwent hepatectomy for the first time and had no history of prior non-index abdominal surgeries,with hepatic inflow occlusion combined with CLCVP from January to December 2019 in Hunan Provincial People’s Hospital.Univariate and multivariate regression analyses were used to identify preoperative and intraoperative risk factors for PHLF.Eligible patients were randomly divided into training and validation groups in a 7:3 ratio,and a nomogram prediction model was constructed.RESULTS The incidence of PHLF in these patients was 22.46%.Multiple logistic analysis showed that preoperative serum albumin level,causes of liver resection(cancer or others),and cirrhosis were independent preoperative risk factors for PHLF(P<0.05)and that only post-blocking blood potassium concentration was an independent intraoperative risk factor for PHLF(P<0.05).Least absolute shrinkage and selection operator regression analysis revealed that preoperative serum albumin level,direct bilirubin level(DBIL),platelet count,causes of liver resection(cancer or others),and cirrhosis were significant predictors of PHLF.The nomogram risk prediction model based on preoperative serum albumin level,DBIL,platelet count,causes of liver resection(cancer or others),cirrhosis and post-blocking blood potassium concentration can better predict the occurrence of PHLF.CONCLUSION For patients undergoing liver resection with CLCVP,serum albumin level,DBIL,platelet count,causes of liver resection(cancer or others),and cirrhosis are independent preoperative risk factors for PHLF.展开更多
The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like ...The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like trans arterial chemoembolization,tyrosine kinase inhibitors,and anti-programmed cell death 1 antibodies have been used as downstaging procedure.Although proper selection of patients is a pre-requisite for salvage related liver failure.展开更多
BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,h...BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,have been limited in patients diagnosed with primary small liver cancer(PSLC).AIM To compare and analyze the clinical efficacy of liver tumor MWA and LH for PSLC.METHODS This study retrospectively analyzed the medical records of 123 patients with PSLC admitted to Xuzhou Central Hospital from January 2015 to November 2022 and categorized them based on treatment modalities into the LH and MWA groups.The LH group,consisting of 61 cases,received LH,and the MWA group,which included 62 cases,underwent liver tumor MWA.Basic data and various periop-erative indicators were compared between the two groups,including changes in liver function indicators[alanine aminotransferase(ALT),glutamic aminotrans-ferase(AST),and total bilirubin(TBIL)]pre-and post-treatment,and efficacy and postoperative complications were analyzed.RESULTS No statistically significant difference was observed between the two groups in terms of age,gender,tumor diameter,liver function Child-Pugh classification and number of tumors,body mass index,and educational status(P>0.05).The overall effective rate was higher in the MWA group than in the LH group(98.39%vs 88.52%)(χ2=4.918,P=0.027).The MWA group exhibited less operation time,intraoperative bleeding,defecation time,and hospital stay than the LH group(P<0.05).No difference was found in liver function indicators between the two groups pre-treatment(P>0.05),and ALT,AST,and TBIL levels decreased in both groups post-treatment,with the MWA group demonstrating lower levels(P<0.05).The MWA and LH groups exhibited postoperative complication rates of 4.84%and 19.67%,respectively,with statistically significant differences between the two groups(P=0.012,χ2=6.318).CONCLUSION MWA is more effective in treating PSLC,and it promotes faster postoperative recovery for patients,and more security improves liver function and reduces postoperative complications compared to LH.展开更多
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
BACKGROUND Traditional postoperative nursing methods implemented after laparoscopic hepatectomy often leads to slow patient recovery.As a new nursing mode,enhanced recovery after surgery(ERAS)has been widely used in t...BACKGROUND Traditional postoperative nursing methods implemented after laparoscopic hepatectomy often leads to slow patient recovery.As a new nursing mode,enhanced recovery after surgery(ERAS)has been widely used in the peri-and postoperative care of patients.However,its effects after laparoscopic hepatectomy remains unclear.AIM To explore the influence of nursing under the ERAS concept on time to first ambulation and complications after laparoscopic hepatectomy.METHODS Data from 119 patients,who underwent laparoscopic hepatectomy for various indications between January 2020 and March 2025,were divided into 2 groups according to nursing mode:Observation[nursing based on the ERAS concept(n=59)],and control[basic nursing(n=60)].Time to first ambulation,complications,length of hospital stay,and numerical rating scale(NRS)scores were compared between the groups.Statistical analysis was performed using SPSS version 26.0(IBM Corp.,Armonk,NY,United States).Differences with P<0.05 were considered statistically significant.RESULTS Findings indicated that after post-nursing intervention,the observation group experienced significantly sooner initial discharge times and shorter hospital stays than the control group(P<0.05).The NRS score of the observation group was lower than that of the control group(P<0.05).The observation group experienced a significantly lower incidence of postoperative complications than the control group(P<0.05).CONCLUSION Operating room nursing based on the ERAS concept significantly shortens the time to first ambulation,reduces the incidence of postoperative complications,and improves patient quality of life after laparoscopic hepatectomy.展开更多
BACKGROUND Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration.These changes impact carbohydrate,lipid,and protein metabolism,as well as energy ...BACKGROUND Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration.These changes impact carbohydrate,lipid,and protein metabolism,as well as energy and oxygen dynamics.A deeper understanding of these shifts is essential for improving perioperative management and enhancing long-term outcomes.AIM To review and synthesise the current understanding of metabolic changes following hepatectomy and explore their implications for perioperative care,postoperative recovery,and long-term patient outcomes.METHODS A narrative review was conducted using PubMed,Cochrane,and Scopus databases to identify relevant human studies published up to December 2024.Search terms included“hepatectomy”,“liver resection”,“metabolic changes”,and related phrases.Studies focusing on metabolic adaptations—specifically changes in glucose,lipid,protein metabolism,and energy consumption—were included.RESULTS Hepatectomy induces a shift toward gluconeogenesis and transient insulin resistance,increased lipid oxidation,amino acid imbalance,and a heightened inflammatory response,especially during ischaemia-reperfusion injury.These changes vary with the extent of resection and the presence of underlying liver disease.Novel insights include the role of the physiologic Pringle manoeuvre(a pharmacologic alternative to mechanical clamping)and metabolomic biomarkers for assessing surgical risk and liver regeneration.CONCLUSION Understanding the metabolic adaptations following hepatectomy provides an opportunity to optimise perioperative care strategies such as nutrition,glucose and lipid management,and mitigation of ischaemia-reperfusion injury.Integrating these insights may enhance surgical outcomes,particularly in patients with hepatocellular carcinoma or non-alcoholic fatty liver disease.展开更多
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has bee...BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has been reported to be associated with high morbidity and mortality.Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.AIM To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.METHODS A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.RESULTS Fifteen patients were included,13 with synchronous liver metastases.Nine patients had more than five liver tumors,with the highest count being 22.The median diameter of the largest lesion was 2.8 cm on preoperative imaging.No extrahepatic metastases were observed.RAS mutations were detected in nine patients,and 14 underwent preoperative chemotherapy.The median increase in future liver remnant volume during the interstage interval was 47.0%.All patients underwent R0 resection.Overall complication rates were 13.3%(stage 1)and 53.3%(stage 2),while major complication rates(Clavien-Dindo≥IIIa)were 13.3%(stage 1)and 33.3%(stage 2).No mortality occurred in either stage.The median hospital stay after stage 2 was 10 days.CONCLUSION Full laparoscopic ALPPS for CRLM is safe and feasible,with the potential for reduced morbidity and mortality,offering radical resection opportunities for patients with initially unresectable CRLM.展开更多
Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and con...Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain： continuous wound catheter （CWC） infiltration, patient-controlled epidural analgesia （PCEA）, patient-controlled intravenous analgesia of morphine （PCIAM）, and patient-controlled intravenous analgesia of sufentanil （PCIAS）. The primary outcome was postoperative visual analogue scale （VAS） scores at rest and on movement. Secondary outcomes included consumption of rescue medication, side effects, and complications associated with postoperative pain management. Results From August 2013 to December 2013, 80 patients were allocated to receive CWC （n=10）, PCEA （n=22）, PCIAM （n=29）, or PCIAS （n=19）. After adjusting for age, sex, body mass index, percentage of resected liver, operation time, and Amsterdam Preoperative Anxiety and Information Scale, there was no significant difference in the VAS scores at rest or on movement between Group CWC and the other groups, namely PCEA, PCIAM, and PCIAS, at 4, 12, 48, and 72 hours postoperatively （all P〉0.05）. The need for rescue medication was not significantly different between Group CWC and the other three groups at 48 and 72 hours postoperatively （all P〉0.05）. There was no significant difference in the incidence of postoperative nausea and vomiting or anal exsufflation time between group CWC and the other three groups （all P〉0.05）. No severe adverse effects associated with continuous wound infiltration were observed during the study period. Conclusions CWC has a comparable analgesic effect compared with traditional analgesia methods at most time points postoperatively. CWC is a safe alternative for the postoperative analgesic management of open liver surgery.展开更多
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
基金supported in part by grants from National Nat-ural Science Foundation of China (82200726 and U23A20451)Key Program of the National Natural Science Foundation of China (81930016)National Key Research and Development Program of China (2021YFA1100500)。
文摘Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.
文摘In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.
文摘Liver regeneration(LR)following partial hepatectomy(PH)is a unique and complex physiological response that restores hepatic mass and function through tightly orchestrated cellular and molecular events.Traditionally viewed as a proliferation-driven process,LR is now understood to involve both hepatocyte hyperplasia and hypertrophy,triggered primarily by hemodynamic alterations such as increased portal pressure and shear stress.These promote LR through endothelial–hepatocyte communication via activation of Piezo1-a mechanosensitive ion channel highly expressed in vascular endothelial cells.This channel is considered one of the potential upstream activators of molecular cascades including the interleukin(IL)-6/signal transducer and activator of transcription 3,tumour necrosis factor-alpha/nuclear factor-kappa B,Wnt/β-catenin,Hippo/YAP,transforming growth factor-beta,and Notch pathways,which contribute variably to the proliferation,differentiation,or suppression of hepatic cells.Novel insights into the IL-22 and IL-33 signaling axes,bile acid and glutamine metabolism,and the role of intestinal microbiota are also presented as promising emerging targets.This review synthesizes current insights into the interplay between mechanical cues,key signaling pathways,and metabolic reprogramming that govern early regenerative responses.We explore the mechanisms dictating the balance between hyperplasia and hypertrophy,noting that hypertrophy predominates after minor resections,while proliferation is dominant in larger resections.Polyploidization emerges as a significant adaptive mechanism,contributing to hepatocyte survival and tissue remodeling.The importance of ductular reactions,microvascular adjustments,and extracellular matrix dynamics in lobular architecture remodeling is also highlighted.The study explores the occurrence of ductular reactions in both minor and major resections,particularly within the granulation tissue near dissection areas.The paper also examines structural remodeling in regenerated liver tissue,demonstrating ongoing transformations in hepatocyte morphology and sinusoidal architecture even months after PH,and emphasizing that the termination of liver mass regrowth does not equate to the cessation of LR.
文摘Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.
基金supported by grants from the National Nat-ural Science Foundation of China(82173129)the Innova-tive and Entrepreneurial Talent Doctor of Jiangsu Province,China(JSSCBS20221872)。
文摘Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
基金Supported by Yunnan Provincial Clinical Medicine Center for Digestive System Diseases,No.2024YNLCYXZX0132.
文摘BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.
文摘BACKGROUND Intraoperative determination of resection margin and adequate residual liver parenchyma are the key points of hepatectomy for the treatment of liver tumors.Intraoperative ultrasound and indocyanine green fluorescence navigation are the most commonly used methods at present,but the technical barriers limit their promotion.AIM To evaluate the value of the three-dimensional location approach with silk thread(3D-LAST)in precise resection of liver tumors.METHODS From September 2020 to January 2022,8 patients with liver tumors including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,hilar cholangiocar-cinoma,and gastric cancer liver metastasis were included in this study.All patients underwent 3D-LAST in precise resection of liver tumors.RESULTS All patients(8/8,100%)underwent the operation successfully without any complications.During the mean follow-up of 8.7 months,all patients survived without tumor recurrence.CONCLUSION In conclusion,the 3D-LAST is a safe and effective new method for liver intraop-erative navigation,which is practical and easy to promote.Core Tip:The aim of this study is to evaluate the value of the three-dimensional location approach with silk thread(3D-LAST)in precise resection of liver tumors.Eight patients with liver tumors including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,hilar cholangiocarcinoma,and gastric cancer liver metastasis underwent the operation successfully without any complications.During the mean follow-up of 8.7 months,all patients survived without tumor recurrence.In conclusion,the 3D-LAST is a safe and effective new method for liver intraoperative navigation,which is practical and easy to promote.INTRODUCTION Hepatectomy is widely used for the treatment of liver tumors.In recent decades,the concept and practice of hepatectomy have developed from irregular,regular and anatomical to the current precise resection.Necessary assistive technologies have enabled these advances.Intraoperative ultrasound(IOUS)localization and indocyanine green(ICG)fluorescence imaging guidance are two frequently-used approaches for laparoscopic hepatectomy[1,2].IOUS is an invaluable auxiliary means widely accepted in surgery for real-time diagnostic information to determine resection range and navigate the surgical path[3].However,the major limitation of IOUS is the time cost during the procedure for paging the sono-graphers and the difficulty of deciphering two dimensional images[4].ICG is a non-toxic water-soluble fluorophore that reveals fluorescence under the near-infrared spectrum[5].Since liver tissue penetration is limited to 5 to 10 mm,that restricted the visualization of deeper tumors by ICG excitation,thereby interfering with its application in laparoscopic hepatectomy[6].IOUS and ICG navigation require specific technical equipment,making implementation difficult in many centers.And these techniques will significantly increase the operation time.Three-dimensional(3D)visualization involves extracting features and producing volumetric images based on computed tomography(CT)through a computer postprocessing technique.This tool offers a reasonable approach to the clinical decision for the potential to display the complex internal anatomy in an intuitive and stereoscopic manner[7].In the past few decades,applying 3D simulation software for liver volume calculation,virtual simulation surgery,portal hypertension monitor,and surgical navigation has proven to be safe and effective[8].Therefore,we propose a new method to find obvious anatomical markers and calculate the resection range according to 3D positioning before operation.During the operation,the scope of resection was delineated with silk thread,and resection was performed.This is a new practical approach,which we named as 3D location approach with silk thread(3D-LAST).RESULTS During the study period from September 2020 to January 2022,5 patients with hepatocellular carcinoma,1 patient with intrahepatic cholangiocarcinoma,1 patient with hilar cholangiocarcinoma,and 1 patient with gastric cancer liver metastasis were assessed for liver resection.There were 5 males and 3 females.The mean age of these patients was 54.3±10.2 years(34-66 years).Preoperative 3D positioning was conducted and the scope of resection was delineated with a surgical suture successfully performed in all 8 patients without complications.The treatment results of these 8 patients are shown in Table 1.The 90-day operative mortality was zero.Complications worse than Dindo-Clavien IIIa was not observed at a mean follow-up time of 8.7 months(4-16 months),there was no evidence of tumor recurrence or extrahepatic metastasis.At the time of reporting,the patients are all alive and lead normal lives.We take one patient as an example,58-year-old male,who found a liver lesion 10 months after gastric cancer surgery.Enhanced CT showed that the lesion was located in the liver S5,about 1.5 cm in diameter,and considered metastatic lesions.We performed 3D-LAST guided hepatectomy on this patient(Figure 1).Other representative 3D-LAST surgical procedures are shown in Figure 2.
文摘To the Editor:Liver transplantation is widely regarded as the definitive treat-ment for patients with end-stage liver disease.However,the per-sistent shortage of cadaveric liver grafts has driven the develop-ment of living-donor liver transplantation(LDLT).Despite its ben-efits,LDLT raises substantial concerns regarding donor morbid-ity,as the procedure involves operating on a healthy individual.Complications associated with donor hepatectomy include abdom-inal trauma,chronic wound pain,physical stress,and psycholog-ical burdens[1,2].In light of these challenges,minimally inva-sive approaches,including laparoscopic and robotic donor hepa-tectomy,have been introduced to mitigate risks and enhance re-covery[3].However,the impact of these techniques on male sex-ual function-a critical aspect of donor quality of life-remains underexplored.Several retrospective studies have highlighted sex-ual dysfunction and altered spousal relationships following open donor hepatectomy[4-6].For instance,9%of donors reported a de-crease in sexual activity,and a significant proportion experienced low body image perceptions.
文摘BACKGROUND Cirrhotic patients with super-giant hepatocellular carcinoma(HCC)and portal vein invasion generally have a poor prognosis.This paper presents a patient with super-giant HCC and portal vein invasion,who underwent hepatectomy followed by a combination of sorafenib and camrelizumab,resulting in complete remission(CR)for 5 years.CASE SUMMARY A 40-year-old male with compensated hepatitis B-related cirrhosis was diagnosed with HCC,Barcelona Clinic Liver Cancer stage C.Enhanced computed tomography imaging revealed a 152 mm×171 mm tumor in the right liver,invading the portal vein and hepatic vein.Liver function was normal.The patient successfully underwent hepatectomy on July 18,2019.However,by December 2019,HCC recurrence with lung metastases and portal vein invasion were detected.He started treatment with sorafenib(200 mg twice daily)and camrelizumab(200 mg every 3 weeks).By May 12,2020,the patient was confirmed to have CR.Camrelizumab was adjusted to 200 mg every 12 weeks from June 16,2021,with the last infusion on March 29,2024.Although no further tumor recurrence was observed,he experienced two episodes of gastrointestinal bleeding due to esophagogastric varices,which were managed with endoscopic therapy.To date,the patient has remained in CR for 5 years.CONCLUSION The combination of hepatectomy with sorafenib and camrelizumab can achieve durable CR in patients with supergiant HCC and portal vein invasion.Further research is necessary to address these challenges and improve patient outcomes.
基金Supported by Education Project of Yunnan Province,No.2024J1628and Project of Qujing Medical College in 2024,No.2024XQ002.
文摘BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).
基金Supported by the Natural Science Foundation of Hunan Province,No.2018JJ3291the Scientific Research Project of the Hunan Provincial Health Commission,No.202104111288.
文摘BACKGROUND Post-hepatectomy liver failure(PHLF),represents a serious complication after liver resection,significantly impacting the long-term outcomes for patients who undergo such surgeries.There exists a strong correlation between intraoperative hemorrhage and transfusion requirements with the development of PHLF.Presently,a combination of hepatic portal occlusion techniques alongside con-trolled low central venous pressure(CLCVP)methodologies is extensively em-ployed to mitigate intraoperative bleeding.Nonetheless,limited studies have analyzed the risk factors for PHLF under CLCVP.AIM To develop and validate a nomogram that predicts the risk factors associated with the development of PHLF patients undergoing liver resection with CLCVP.METHODS We conducted a retrospective analysis of 285 patients who underwent hepatectomy for the first time and had no history of prior non-index abdominal surgeries,with hepatic inflow occlusion combined with CLCVP from January to December 2019 in Hunan Provincial People’s Hospital.Univariate and multivariate regression analyses were used to identify preoperative and intraoperative risk factors for PHLF.Eligible patients were randomly divided into training and validation groups in a 7:3 ratio,and a nomogram prediction model was constructed.RESULTS The incidence of PHLF in these patients was 22.46%.Multiple logistic analysis showed that preoperative serum albumin level,causes of liver resection(cancer or others),and cirrhosis were independent preoperative risk factors for PHLF(P<0.05)and that only post-blocking blood potassium concentration was an independent intraoperative risk factor for PHLF(P<0.05).Least absolute shrinkage and selection operator regression analysis revealed that preoperative serum albumin level,direct bilirubin level(DBIL),platelet count,causes of liver resection(cancer or others),and cirrhosis were significant predictors of PHLF.The nomogram risk prediction model based on preoperative serum albumin level,DBIL,platelet count,causes of liver resection(cancer or others),cirrhosis and post-blocking blood potassium concentration can better predict the occurrence of PHLF.CONCLUSION For patients undergoing liver resection with CLCVP,serum albumin level,DBIL,platelet count,causes of liver resection(cancer or others),and cirrhosis are independent preoperative risk factors for PHLF.
文摘The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like trans arterial chemoembolization,tyrosine kinase inhibitors,and anti-programmed cell death 1 antibodies have been used as downstaging procedure.Although proper selection of patients is a pre-requisite for salvage related liver failure.
文摘BACKGROUND In-depth comparative investigations in terms of clinical efficacies of liver tumor microwave ablation(MWA)and laparoscopic hepatectomy(LH),which are both important treatment modalities for liver neoplasms,have been limited in patients diagnosed with primary small liver cancer(PSLC).AIM To compare and analyze the clinical efficacy of liver tumor MWA and LH for PSLC.METHODS This study retrospectively analyzed the medical records of 123 patients with PSLC admitted to Xuzhou Central Hospital from January 2015 to November 2022 and categorized them based on treatment modalities into the LH and MWA groups.The LH group,consisting of 61 cases,received LH,and the MWA group,which included 62 cases,underwent liver tumor MWA.Basic data and various periop-erative indicators were compared between the two groups,including changes in liver function indicators[alanine aminotransferase(ALT),glutamic aminotrans-ferase(AST),and total bilirubin(TBIL)]pre-and post-treatment,and efficacy and postoperative complications were analyzed.RESULTS No statistically significant difference was observed between the two groups in terms of age,gender,tumor diameter,liver function Child-Pugh classification and number of tumors,body mass index,and educational status(P>0.05).The overall effective rate was higher in the MWA group than in the LH group(98.39%vs 88.52%)(χ2=4.918,P=0.027).The MWA group exhibited less operation time,intraoperative bleeding,defecation time,and hospital stay than the LH group(P<0.05).No difference was found in liver function indicators between the two groups pre-treatment(P>0.05),and ALT,AST,and TBIL levels decreased in both groups post-treatment,with the MWA group demonstrating lower levels(P<0.05).The MWA and LH groups exhibited postoperative complication rates of 4.84%and 19.67%,respectively,with statistically significant differences between the two groups(P=0.012,χ2=6.318).CONCLUSION MWA is more effective in treating PSLC,and it promotes faster postoperative recovery for patients,and more security improves liver function and reduces postoperative complications compared to LH.
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
文摘BACKGROUND Traditional postoperative nursing methods implemented after laparoscopic hepatectomy often leads to slow patient recovery.As a new nursing mode,enhanced recovery after surgery(ERAS)has been widely used in the peri-and postoperative care of patients.However,its effects after laparoscopic hepatectomy remains unclear.AIM To explore the influence of nursing under the ERAS concept on time to first ambulation and complications after laparoscopic hepatectomy.METHODS Data from 119 patients,who underwent laparoscopic hepatectomy for various indications between January 2020 and March 2025,were divided into 2 groups according to nursing mode:Observation[nursing based on the ERAS concept(n=59)],and control[basic nursing(n=60)].Time to first ambulation,complications,length of hospital stay,and numerical rating scale(NRS)scores were compared between the groups.Statistical analysis was performed using SPSS version 26.0(IBM Corp.,Armonk,NY,United States).Differences with P<0.05 were considered statistically significant.RESULTS Findings indicated that after post-nursing intervention,the observation group experienced significantly sooner initial discharge times and shorter hospital stays than the control group(P<0.05).The NRS score of the observation group was lower than that of the control group(P<0.05).The observation group experienced a significantly lower incidence of postoperative complications than the control group(P<0.05).CONCLUSION Operating room nursing based on the ERAS concept significantly shortens the time to first ambulation,reduces the incidence of postoperative complications,and improves patient quality of life after laparoscopic hepatectomy.
文摘BACKGROUND Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration.These changes impact carbohydrate,lipid,and protein metabolism,as well as energy and oxygen dynamics.A deeper understanding of these shifts is essential for improving perioperative management and enhancing long-term outcomes.AIM To review and synthesise the current understanding of metabolic changes following hepatectomy and explore their implications for perioperative care,postoperative recovery,and long-term patient outcomes.METHODS A narrative review was conducted using PubMed,Cochrane,and Scopus databases to identify relevant human studies published up to December 2024.Search terms included“hepatectomy”,“liver resection”,“metabolic changes”,and related phrases.Studies focusing on metabolic adaptations—specifically changes in glucose,lipid,protein metabolism,and energy consumption—were included.RESULTS Hepatectomy induces a shift toward gluconeogenesis and transient insulin resistance,increased lipid oxidation,amino acid imbalance,and a heightened inflammatory response,especially during ischaemia-reperfusion injury.These changes vary with the extent of resection and the presence of underlying liver disease.Novel insights include the role of the physiologic Pringle manoeuvre(a pharmacologic alternative to mechanical clamping)and metabolomic biomarkers for assessing surgical risk and liver regeneration.CONCLUSION Understanding the metabolic adaptations following hepatectomy provides an opportunity to optimise perioperative care strategies such as nutrition,glucose and lipid management,and mitigation of ischaemia-reperfusion injury.Integrating these insights may enhance surgical outcomes,particularly in patients with hepatocellular carcinoma or non-alcoholic fatty liver disease.
基金Supported by Natural Science Foundation of Guangdong Province of China,No.2024A1515012862.
文摘BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has been reported to be associated with high morbidity and mortality.Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.AIM To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.METHODS A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.RESULTS Fifteen patients were included,13 with synchronous liver metastases.Nine patients had more than five liver tumors,with the highest count being 22.The median diameter of the largest lesion was 2.8 cm on preoperative imaging.No extrahepatic metastases were observed.RAS mutations were detected in nine patients,and 14 underwent preoperative chemotherapy.The median increase in future liver remnant volume during the interstage interval was 47.0%.All patients underwent R0 resection.Overall complication rates were 13.3%(stage 1)and 53.3%(stage 2),while major complication rates(Clavien-Dindo≥IIIa)were 13.3%(stage 1)and 33.3%(stage 2).No mortality occurred in either stage.The median hospital stay after stage 2 was 10 days.CONCLUSION Full laparoscopic ALPPS for CRLM is safe and feasible,with the potential for reduced morbidity and mortality,offering radical resection opportunities for patients with initially unresectable CRLM.
文摘Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain： continuous wound catheter （CWC） infiltration, patient-controlled epidural analgesia （PCEA）, patient-controlled intravenous analgesia of morphine （PCIAM）, and patient-controlled intravenous analgesia of sufentanil （PCIAS）. The primary outcome was postoperative visual analogue scale （VAS） scores at rest and on movement. Secondary outcomes included consumption of rescue medication, side effects, and complications associated with postoperative pain management. Results From August 2013 to December 2013, 80 patients were allocated to receive CWC （n=10）, PCEA （n=22）, PCIAM （n=29）, or PCIAS （n=19）. After adjusting for age, sex, body mass index, percentage of resected liver, operation time, and Amsterdam Preoperative Anxiety and Information Scale, there was no significant difference in the VAS scores at rest or on movement between Group CWC and the other groups, namely PCEA, PCIAM, and PCIAS, at 4, 12, 48, and 72 hours postoperatively （all P〉0.05）. The need for rescue medication was not significantly different between Group CWC and the other three groups at 48 and 72 hours postoperatively （all P〉0.05）. There was no significant difference in the incidence of postoperative nausea and vomiting or anal exsufflation time between group CWC and the other three groups （all P〉0.05）. No severe adverse effects associated with continuous wound infiltration were observed during the study period. Conclusions CWC has a comparable analgesic effect compared with traditional analgesia methods at most time points postoperatively. CWC is a safe alternative for the postoperative analgesic management of open liver surgery.
