Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
권호 표지

Suprahilar Control of Glissonean Pedicle in the Open Anatomic Liver Resections: A Single Centre Experience

  • Received : 2016.11.22
  • Accepted : 2016.12.23
  • Published : 2016.12.31
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Abstract

Background: We evaluated technique of hepatic resections using suprahilar-extrafascial dissection of Glissonean pedicle with vascular stapling device for pedicle transection with intent to minimize operative time and blood loss. Methods: We analyzed the clinical records of 326 patients who underwent anatomic liver resection by suprahilar-extrafascial pedicle isolation with vascular stapling division technique. Results: The minor liver resections were associated with significantly shorter surgery duration (105.1±21.1 vs. 225.6±75.6) and transection time (40.1±14.5 vs. 96.3±55.2) than major hepatectomies (p<0.0001 for all). The mean blood loss was 350.8±100.5 mL in minor resection and 485.4±250.2 mL in major resection (p=0.001). The mean blood transfusion requirement was 400.8±109.5 mL for minor resections and 550.9±100.0 mL for major hepatectomy (p=0.072). There was no significant difference in morbidity and mortality between groups (p=0.980; p=0.945). Major as well as minor liver resection were oncology superior with no significant difference in the 5-year overall survival rates. Conclusion: Suprahilar-extrafascial dissection of Glissonean pedicle represents an effective and safe technique of liver resection. Presented approach allows early and easy ischemic delineation of appropriate liver territory to be removed with selective inflow vascular control. It is not time consuming and it is very useful in re-resection, as well as oncological reasonable.

Keywords

References

  1. Dan RG, Cretu OM, Mazilu O, et al. Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients. Chirurgia (Bucur) 2012;107:737-741.
  2. Chirica M, Scatton O, Massault PP, et al. Treatment of stage IVA hepatocellular carcinoma: should we reappraise the role of surgery? Arch Surg 2008;143:538-543.
  3. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for respectability of colorectal liver metastases. Oncologist 2008;13:51-64.
  4. Gonzalez HD, Figueras J. Practical questions in liver metastases of colorectal cancer: general principles of treatment. HPB (Oxford) 2007;9:251-258.
  5. Minagawa M, Yamamoto J, Miwa S, et al. Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg 2006;141:1006-1012.
  6. Nuzzo G, Giuliante F, Ardito F, et al. Liver resection for primarily unresectable colorectal metastases downsized by chemotherapy. J Gastrointest Surg 2007;11:318-324.
  7. Figueras J, Lopez-Ben S, Llado L, et al. Hilar dissection versus the 'Glissonian' approach and stapling of the pedicle for major hepatectomies: a prospective, randomized trial. Ann Surg 2003;238:111-119.
  8. Aragon RJ, Solomon NL. Techniques of hepatic resection. J Gastrointest Oncol 2012;3:28-40.
  9. Doklestic K, Karamarkovic A, Stefanovic B, et al. The efficacy of three transection techniques of the liver resection: a randomized clinical trial. Hepatogastroenterology 2012;59:1501-1506.
  10. Lortat-Jacob JL, Robert HG. Hepatectomiedroiteregl?. Press Med 1952;60:549-551.
  11. Meunier B, Lakehal M, Tay KH, et al. Surgicalcomplications and treatment during resection for malignancy of the high bile duct. World J Surg 2001;25:1284-1288.
  12. Lo CM, Fan ST, Liu CL, et al. Biliary complications afterhepatic resection: risk factors, management and outcome. Arch Surg 1998;133:156-161.
  13. Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria forsafe hepatic resection. Am J Surg 1995;169:589-594.
  14. Icoz G, Kilic M, Zeytunlu M, et al. Biliary reconstructionsand complications encountered in 50 consecutive right lobe living donor liver transplantation. Liver Transpl 2003;9:575-580.
  15. Couinaud C. Le foie. Etudes Anatomiqueset Chirugicales. Paris: Masson, 1957.
  16. Tung TT. Les Resections Majeureset Mineures du Fois. Paris: Masson & Cie, 1957.
  17. Couinaud CM. A simplified method for controlled left hepatectomy. Surgery 1985;97:358-361.
  18. Lazorthes F, Chiotasso P, Chevreau P, et al. Hepatectomy with initial suprahilar control of intrahepatic portal pedicles. Surgery 1993;113:103-108.
  19. Takasaki K. eds. Glissonean pedicle transection method for hepatic resection. Tokyo: Springer, 2007.
  20. Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 1998;5:286-291.
  21. Galperin EI, Karagiulian SR. A new simplified methodof selective exposure of hepatic pedicles for controlled hepatectomies. HPB Surgery 1989;1:119-130.
  22. Launois B, Jamieson GG. The importance of Glisson's capsule and its sheaths in the intrahepatic approach to resection of the liver. Surg Gynecol Obstet 1992;174:7-10.
  23. Machado MA, Herman P, Machado MC. A standardized technique for right segmental liver resections. Arch Surg 2003;138:918-920.
  24. Machado MA, Herman P, Machado MC. Anatomical resection of left liver segments. Arch Surg 2004;139:1346-1349.
  25. Machado MA, Herman P, Meirelles RF Jr, et al. How I do it: bi-segmentectomy V-VIII as alternative to right hepatectomy: an intrahepatic approach. J Surg Oncol 2005;90:43-45.
  26. Fong Y, Blumgart L. Useful stapling techniques in liversurgery. J Am Coll Surg 1997;185:93-100.
  27. Ramacciato G, Aurello P, D'Angelo F, et al. Effective vascular endostapler techniques in hepatic resection. Int Surg 1998;83:317-323.
  28. Wang WX, Fan ST. Use of the Endo-GIA vascular staplerfor hepatic resection. Asian J Surg 2003;26:193-196.
  29. DeMatteo RP, Fong Y, Jarnagin WR, et al. Recent advances in hepatic resection. Semin Surg Oncol 2000;19:200-207.
  30. Schemmer P, Friess H, Hinz U, et al. Stapler hepatectomy is a safe dissection technique: analysis of 300 patients. World J Surg 2006;30:419-430.
  31. Bagul A, McMahon G, Alam F, et al. Safely dealing withthe right hepatic vein during a right hepectomy. Ann R Coll Surg Engl 2010;92:442-443.
  32. Karamarkovic A, Doklestic K, Milic N, et al. Glissonean pedicle approach in major liver resections. Hepatogastroenterology 2012;59:1896-1901.
  33. Pang YY. The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000;2:333-339.
  34. Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004;240:698-708.
  35. Poon RT. Current techniques of liver transection. HPB (Oxford) 2007;9:166-173.
  36. Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred fourtyseven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000;191:38-46.
  37. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg 1982;6:3-9.
  38. Yamamoto M, Katagiri S, Ariizumi S, et al. Glissonean pedicle transection method for liver surgery. J Hepatobiliary Pancreat Sci 2012;19:3-8.
  39. Nanashima A, Sumida Y, Oikawa M, et al. Vasculartransection using endovascular stapling in hepatic resection. Hepatogastroenterology 2009;56:498-500.
  40. Boudjema K, Veilhan LA, Dupont-Bierre E, et al. Two tapes to control the main fissure of the liver. Ann Chir 2002;127:149-153.
  41. Kim SH, Park SJ, Lee SA, et al. Various liver resections using hanging maneuver by three Glisson's pedicles and three hepatic veins. Ann Surg 2007;245:201-205.
  42. Cresswell AB, Welsh FK, John TG, et al. Evaluation of intrahepatic, extra-Glissonian stapling of the right porta hepatis vs. classical extrahepatic dissection during right hepatectomy. HPB (Oxford) 2009;11:493-498.
  43. Smyrniotis V, Arkadopoulos N, Theodoraki K, et al. Association between biliary complications and technique of hilar division (extrahepatic vs. intrahepatic) in majorliver resections. World J Surg Oncol 2006;4:59.
  44. Giordano M, Lopez-Ben S, Codina-Barreras A, et al. Extra-Glissonian approach in liver resection. HPB (Oxford) 2010;12:94-100.
  45. Mouly C, Fuks D, Browet F, et al. Feasibility of the Glissonian approach during right hepatectomy. HPB (Oxford) 2013;15:638-645.
  46. Yamamoto M, Katagiri S, Ariizumi SI, et al. Tips for anatomical hepatectomy for hepatocellular carcinoma by the Glissonean pedicle approach. J Hepatobiliary Pancreat Sci 2014;21:E53-56.
  47. Launois B. General principles of liver surgery. The posterior intrahepatic approach in liver surgery. New York, USA: Springer, 2013.
  48. Stewart GD, O'Suilleabhain CB, Madhavan KK, et al. The extent of resection influences outcome following hepatectomy for colorectal liver metastases. Eur J Surg Oncol 2004;30:370-376.
  49. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections. A prospective randomized trial. Ann Surg 2005;241:582-590.
  50. Makuuchi M, Mori T, Gunven P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet 1987;164:155-158.
  51. Delis SG, Bakoyiannis A, Karakaxas D, et al. Hepatic parenchyma resection using stapling devices: peri-operative and longterm outcome. HPB (Oxford) 2009;11:38-44.
  52. Jarnagin WR, Gonen M, Fong Y, et al. Improvement inperioperative outcome after hepatic resection. Analysis of 1803 consecutive cases over the past decade. Ann Surg 2002;236:397-406.
  53. Capussotti L, Ferrero A, Vigano L, et al. Bile leakage andliver resection: where is the risk? Arch Surg 2006;141:690-694.
  54. Nagano Y, Togo S, Tanaka K, et al. Risk factors and management of bile leakage after hepatic resection. World J Surg 2003;27:695-698.
  55. Karamarkovic A, Doklestic K, Popovic N, Gregoric P, Vujadinovic ST, Milic N. Suprahilar vascular control and stapling device transection of Glissonian pedicle in major and minor hepatectomies. Hepato-Gastroenterol 2013;60(128):2060-2068.