12. Survival outcomes of hepatectomy for hepatocellular carcinoma using LigaSure and Kelly forceps for parenchymal excision combined Glissonean pedicle approach: A retrospective single-centre study

Tran Que Son, Tran Manh Hung, Tran Hieu Hoc, Trieu Van Truong, Nguyen Toan Thang, Pham Van Tuyen, Nguyen Tuan Thanh, Ngo Quang Dinh, Bui Thi Minh Hue, Nguyen Van Minh, Cu Trung Kien, Nguyen Trung Kien, Do Duc Minh, Vu Thi Nha, Do Quoc Viet

Nội dung chính của bài viết

Tóm tắt

 


Standard procedures in hepatectomy for hepatocellular carcinoma (HCC) include selective pedicle control and anatomical liver resection. We provide our experience using LigaSureTM and Kelly forceps for parenchymal excision combined with the Glissonian pedicle approach for HCC patients. Sixty-seven patients underwent hepatectomy between June 1st 2016 and May 30th 2020. Prospectively gathered data on surgical outcomes and long-term survival results are given. Minor liver resections comprise 85% of all surgical procedures. The median operative time was 132.1 minutes (range, 102 to 195 mins), and the median intraoperative estimated blood loss was 210 ± 158 (range, 150 – 750) mL. The rate of morbidity was 17.9%, including pleural effusion (13,4%), biliary fistula (0%), liver failure (1.5%), and intra-abdominal bleeding (1.5%). The mean overall survival time by Kaplan – Meier method is 33 ± 0.6 months. The rate of overall survival after 1, 2, and 3 years was 95.5%, 84.5% and 79.4%, respectively. The mean disease-free survival (DFS) time was 25.9 ± 2.1 (months). The recurrence rates after 3 months, 6 months, 12 months, and 24 months were 9.6%, 12.4%, 30.5%, and 42.6%, respectively. Conclusion: In a nation with minimal assets, the Glissonian pedicle approach with the Ligasure and Kelly forceps is a safe and successful method for performing hepatectomy. It permits an anatomical excision with minor morbidity when operated by experienced surgeons.

Chi tiết bài viết

Author Biographies

Tran Manh Hung,

 

 

Tran Hieu Hoc,

 

 

Trieu Van Truong,

 

 

Nguyen Toan Thang,

 

 

Pham Van Tuyen,

 

 

Nguyen Tuan Thanh,

 

 

Ngo Quang Dinh,

 

 

Bui Thi Minh Hue,

 

 

Nguyen Van Minh,

 

 

Cu Trung Kien,

 

 

Nguyen Trung Kien,

 

 

Do Duc Minh,

 

 

Vu Thi Nha,

 

 

Do Quoc Viet,

 

 

Tài liệu tham khảo

1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nature Reviews Disease Primers. 2021;7(1):6-10.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
3. Van Ha Q, Nguyen TH, Van Nguyen H, et al. Hepatectomy using a combination of extrafascial extrahepatic (Takasaki approach) and extrafascial intrahepatic pedicle approaches (Ton That Tung approach). J Surg Case Rep. 2021;2021(10):rjab419.
4. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358-80.
5. Mai RY, Bai T, Luo XL, et al. Indocyanine Green Retention Test as a Predictor of Postoperative Complications in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma. Ther Clin Risk Manag. 2022;18:761-72.
6. Ton That Tung, Quang ND. A new technique for operating on the liver. The Lancet. 1963;281:192-3.
7. Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg. 1998;5(3):286-91.
8. Liang X, Zheng J, Xu J, et al. Laparoscopic anatomical portal territory hepatectomy using Glissonean pedicle approach (Takasaki approach) with indocyanine green fluorescence negative staining: how I do it. HPB (Oxford). 2021;23(9):1392-9.
9. Yamamoto M, Takasaki K, Ohtsubo T, et al. Effectiveness of systematized hepatectomy with Glisson’s pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery. 2001;130(3):443-8.
10. Karamarkovic A, Doklestic K. Pre-resectional inflow vascular control: extrafascial dissection of Glissonean pedicle in liver resections. Hepatobiliary Surg Nutr. 2014;3(5):227-37.
11. Yamamoto M, Ariizumi SI. Glissonean pedicle approach in liver surgery. Ann Gastroenterol Surg. 2018;2(2):124-8.
12. Ho VL, Pham NH, Nguyen TX, et al. Hepatectomy with Takasaki’s Technique Using SonaStar Ultrasonic Aspiration System: An Experience from 58 Cases. Clin Exp Gastroenterol. 2021;14:297-302.
13. Nguyen TH, Ha QV, Nguyen HV, et al. Survival outcomes of the combination of extrafascial extrahepatic and extrafascial intrahepatic pedicle approaches in hepatectomy for hepatocellular carcinoma. Clin Exp Hepatol. 2022;8(2):147-52.
14. Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205-13.
15. Balzan S BJ, Farges O. The “50 - 50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Annals of surgery. 2005;242(6):824-9.
16. JS, Fu Q,Wuyun G. Management of post-hepatectomy complications. World journal of gastroenterology. 2013;19(44):7983-91.
17. Tanaka K, Nojiri K, Sawada Y, et al. Predictive factors for bile leakage after hepatectomy for hepatic tumors: a retrospective multicenter study with 631 cases at Yokohama Clinical Oncology Group (YCOG). Journal of hepato-biliary-pancreatic sciences. 2017;24(1):33-41.
18. Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156-65.
19. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: Analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397-406; discussion -7.
20. Yamashita YI, Yamamoto H, Miyata H, et al. Risk factors for bile leakage: Latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database. J Hepatobiliary Pancreat Sci. 2021;28(7):556-62.
21. Balzan S, Belghiti J, Farges O, et al. The “50 - 50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824-8, discussion 8-9.
22. Sapisochin G, Castells L, Dopazo C, et al. Single HCC in cirrhotic patients: liver resection or liver transplantation? Long-term outcome according to an intention-to-treat basis. Ann Surg Oncol. 2013;20(4):1194-202.
23. Zhang TT, Zhao XQ, Liu Z, et al. Factors affecting the recurrence and survival of hepatocellular carcinoma after hepatectomy: A retrospective study of 601 Chinese patients. Clin Transl Oncol. 2016;18(8):831-40.