|OL04 Liver: Technical Surgery
|Selection of Presentations from Abstract Submissions
|OL04-02 ||Robotic versus Open Hepatectomy for Hepatocellular Carcinoma: A Retrospective Propensity-Matched Analysis
John Wong, China
J. Wong, K.F. Lee, C.C.N. Chong, A.K.Y. Fung, H.T. Lok, Y.S. Cheung, K.C. Ng, P.B.S. Lai
Department of Surgery, Chinese University of Hong Kong, China
Introduction: The aim of this study was to compare the short and long term outcomes of robotic hepatectomy with open hepatectomy for hepatocellular carcinoma (HCC).
Method: Data for patients who underwent robotic hepatectomy for HCC from September 2010 to September 2019 were retrieved from the departmental hepatectomy database. Propensity scores were calculated using the following factors: gender, age, American Society of Anaesthesiologists score, Child's grading, hepatitis status, magnitude of resection, size and number of tumor and vascular invasion. These robotic cases were matched with a similar group of patients who underwent open hepatectomy in a 1:1 ratio within this 9-year period.
Results: Eighty-five patients in the robotic group was compared to 85 patients in the open group. The two groups were comparable in patient demographics, disease characteristics and magnitude of resection. Blood loss was less in the robotic group (148ml vs 437ml, P< 0.001). Hospital stay was shorter in the robotic group (4 vs 9 days, P< 0.001). There were less major complications in the robotic group (n=1 vs n=11, P=0.006). The 5-year overall survival was significantly better after robotic surgery (85.2% vs 67.4%, P=0.015). The operative time, transfusion requirement, margin involvement, 30-day mortality, disease-free survival and choice for subsequent treatment of HCC recurrence all showed no difference among the two groups.
Conclusions: Robotic hepatectomy for HCC could be achieved with reduced blood loss, less major complications and shorter hospitalization, as compared to open hepatectomy. It could also achieve a better 5-year overall survival.
|OL04-04 ||The Most Minimally-invasive ALPPS - Using Terminal Branches Portal Vein Embolization (TBPVE) for Liver Partition (A Report of 24 Cases)
Xu An Wang, China
S.Y. Peng1, X.A. Wang2, C.Y. Huang3, Y.Y. Zhang3, Y.F. Wang4, J.W. Wang1, J.T. Li1, D.F. Hong4, X.J. Cai4
1The 2nd Affiliated Hospital of Zhejiang University, China, 2Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China, 3Yuebei People's Hospital, China, 4Sir Run Run Shaw Hospital, the Zhejiang University College of Medicine, China
Introduction: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a minimally-invasive way to partition the liver. The intra-hepatic portal vein communication can thus be blocked between both liver. As a result, only a single surgical operation is required. This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP).
Methods: From February 2016 to November 2017, 24 patients were performed with TELPP. The procedure was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5, S8 or S4. In order to avoid potential enlargement of tumor, in some cases tumor TACE were used at the same time. Standard liver volume(SLV), future liver remnant (FLR) and FLR／SLV are calculated by CT scan taken. Open or laparoscopic hepatectomy was performed in two weeks when the FLR is appropriate.
Results: All the patients (most of the liver were cirrhotic；4 patients with PVTT) achieved enough FLR that had a median increase of 55.6% (from 26.2% to 120.8%) in two weeks. All of them underwent hepatectomy, most of them were extended hemihepatectomy and trisegmentectomy. No server morbidity occurred except 1 case with minor ectopic thrombus. 3 patients died respectively 15,18,7 months, all the other 21 patients are surviving.
Conclusion: This study shows that TBPVE had a rapid FLR increase similar to ALPPS without it's drawback. TELPP is very promising, cause requiring only one single operation instead of two staged operations.
|OL04-05 ||Venous Reconstruction with the Parietal Peritoneum. the Long Term Patency Rate According to the Type of Resected Vein in 141 Patients
Safi Dokmak, France
S. Dokmak, B. Aussilhou, F. Cauchy, A. Sauvanet, O. Soubrane
HBP Departement and Liver Transplantation, Beaujon Hospital, France
Objective: We recently described venous reconstruction during
HPB surgery with the parietal peritoneum (PP). Our aim is to evaluate the long
term patency rate according to the
2010-2019, 141 patients underwent pancreatic (n=100) or liver (n=41) resections with reconstruction of the mesentericoportal vein (96), the
vena cava (21), hepatic veins (12), portal confluence (12) with the PP. The PP (mean length=26 mm; 10-100) was harvested from the falciform ligament (n=65),
hypochondrium (n=26), diaphragm (n=24), or prerenal (n=26) area. Reconstruction
was lateral in 136 patients, tubular in 5
patients and urgent in 14. Postoperative anticoagulation was standard and venous
patency and stenosis was assessed by routine CT scans. The mean radiological
follow-up was 14 (2-65) months.
mean age was 61 (31- 84), females (54; 38%) and transfusion (35; 25%). Two non related mortalities, overall morbidity
(n=66; 47%) and the mean hopsital stay was 18(5-75) with no PP-related or haemorraghic
complications. The global patency rate was (n=126 ; 90%) including 17 (13%)
with moderate stenosis. In patients with complete stenosis (n=15; 10%),
symptomatic thrombosis necessitating reintervention was observed in one patient
(< 1%). The patency rate for the vena cava, hepatic veins and the portal
confluence (n=45) was 100% and for the mesentercioportal vein (n=96) was 84%. Complete thrombosis was mainly observed after
tubular reconstruction (2/15) and distal pancreatectomy (10/15).
PP showed globally a high patency rate in HBP surgery, which was excellent after liver surgery.
|OL04-07 ||Augmented Reality and the Novel Use of Indocyanine Green as a Navigational Adjunct for Laparoscopic Ablation of Liver Tumors
David Gerber, United States
D. Gerber, P. Serrano, A. Toledo, V. Adarsh, C. Desai
Surgery, University of North Carolina, United States
Introduction: Laparoscopy can be used
as an adjunct to successfully treat hepatocellular carcinoma nodules, as
the surgeon manipulates the liver under direct visualization. To successfully perform laparoscopic
assisted thermal ablation the surgeon must be skilled at ultrasound to identify the tumor nodule(s). In this study we introduce a novel adjunct to
laparoscopic assisted microwave ablation via IV infusion of
indocyanine green (ICG) dye.
Methods: 25 patients with cirrhosis and MRI-diagnosed hepatocellular carcinoma
nodules received ICG (0.3125 -0.625 mg) to distinguish tumor nodules from
surrounding regenerative nodules in cirrhotic livers. After infusion a fluorescence system for intraoperative laparoscopic imaging is used to
capture the images. The light source is a light-emitting diode (LED) and the
detector is a charge-coupled device (CCD) camera.
Results: 25 patients were administered low-dose ICG . Contrasting hypoperfusion of the HCC nodules (n=30) is identified within 5 minutes of infusion. Accuracy of HCC nodule identification=100% (Sensitivity = 100%; Specificity = 100%). Figure 1
Conclusions: Low-dose ICG infusion can safely be administered as a real-time operative adjunct and provides visualization that augments the ability to identify HCC nodules based on hypoperfusion characteristics of HCC nodules compared with regenerative nodules.
[Figure 1. ICG infusion with isolation of solitary HCC nodule]