Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Cirrhosis ; etiology ; surgery ; Liver Neoplasms ; complications ; surgery

Portal venous tumor emboli is one of the important factors that affect the prognosis of patients with hepatocellular carcinoma (HCC). There are different characters of surgery, interventional therapy, radiation therapy, treatment of local damage, targeted therapy in the treatment of portal venous tumor emboli, but the effects are not ideal. Scholars at home and abroad are exploring a variety of treatment patterns in the treatment of portal venous tumor emboli, to achieve better effect.Predominantly surgical comprehensive treatment can excision of tumor and tumor emboli, improve liver function, improve the quality of survival, prolong survival time. But the operation risk is big. Mainly non-surgical treatment has advantages of little trauma, less risk, and better local control of tumor emboli. But the efficiency, effect, alleviate period is ineffective. Therefore, the best treatment mode should be explored according to the different tumor emboli parting.
Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Neoplasms ; complications ; surgery ; Neoplastic Cells, Circulating ; Portal Vein ; Prognosis ; Thrombosis ; complications ; surgery

Carcinoma, Hepatocellular ; surgery ; Catheter Ablation ; adverse effects ; Humans ; Liver Neoplasms ; surgery ; Postoperative Complications ; etiology ; prevention & control

Laparoscopic liver resection (LLR) is becoming widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic left lateral sectionectomy and minor laparoscopic liver resection are now considered standard approaches, especially for tumors located in the anterolateral segments of the liver. Laparoscopic left lateral sectionectomy in adult donors is also gaining acceptance for child liver transplantation in many centers. Major LLRs, including left hepatectomy and right hepatectomy, have been recently attempted. Laparoscopic donor hepatectomy is becoming more popular owing to increasing demand from young living donors who appreciate its minimal invasiveness and excellent cosmetic outcomes. Several centers have performed total laparoscopic donor right hepatectomy in adult-to-adult living donor liver transplantation. Many meta-analyses have shown that LLR is better than open liver resection in terms of short-term outcomes, principally cosmetic outcomes. Although no randomized control trials have compared LLR with open liver resection, the long-term oncologic outcomes were similar for both procedures in recent case-matched studies.
Carcinoma, Hepatocellular/complications/pathology/*surgery ; Humans ; Laparoscopy ; Liver Cirrhosis/complications ; Liver Neoplasms/pathology/*surgery ; Neoplasm Recurrence, Local ; Prognosis

Laparoscopic liver resection (LLR) is becoming widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic left lateral sectionectomy and minor laparoscopic liver resection are now considered standard approaches, especially for tumors located in the anterolateral segments of the liver. Laparoscopic left lateral sectionectomy in adult donors is also gaining acceptance for child liver transplantation in many centers. Major LLRs, including left hepatectomy and right hepatectomy, have been recently attempted. Laparoscopic donor hepatectomy is becoming more popular owing to increasing demand from young living donors who appreciate its minimal invasiveness and excellent cosmetic outcomes. Several centers have performed total laparoscopic donor right hepatectomy in adult-to-adult living donor liver transplantation. Many meta-analyses have shown that LLR is better than open liver resection in terms of short-term outcomes, principally cosmetic outcomes. Although no randomized control trials have compared LLR with open liver resection, the long-term oncologic outcomes were similar for both procedures in recent case-matched studies.
Carcinoma, Hepatocellular/complications/pathology/*surgery ; Humans ; Laparoscopy ; Liver Cirrhosis/complications ; Liver Neoplasms/pathology/*surgery ; Neoplasm Recurrence, Local ; Prognosis

OBJECTIVETo clarify the proper surgical procedure of treating hepatocellular carcinoma (HCC) with a tumor thrombus in the inferior vena cava (IVC).

METHODSFour patients with HCC with a tumor thrombus in the IVC underwent hepatectomy and thrombectomy. Following hepatectomy, tumor thrombus was removed by incising the wall of the IVC in 3 patients and from the hepatic vein in one patient. The 3 patients underwent thrombectomy under either hepatic vascular exclusion (HVE) or Satinsky's vascular clamping.

RESULTSAll the operations were successful without operative death and major complications. The postoperative course was uneventful in 3 patients and pleural effusion occurred in one patient who needed thoracentesis. Follow-up showed 3 patients died after 30, 10 and 14 months, respectively, and one patient is alive for 7 months.

CONCLUSIONSHCC with tumor thrombus in the IVC is operable and the proper procedure is hepatectomy plus thrombectomy.

Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; Vena Cava, Inferior ; pathology

No abstract available.
Carcinoma, Hepatocellular/complications/*diagnosis/*surgery ; Humans ; Liver Cirrhosis/complications/*diagnosis/*surgery ; Liver Function Tests ; Liver Neoplasms/complications/*diagnosis/*surgery ; *Postoperative Complications ; Prognosis

Hypersplenism, secondary to portal hypertension, is common in hepatocellular carcinoma (HCC) with liver cirrhosis. Hepatic resection in the patient with hypersplenic thrombocytopenia (HSTC) may cause a perioperative bleeding episode and sometimes, liver failure. In order to investigate the effect of concomitant splenectomy in HCC patients with HSTC, clinical parameters are retrospectively reviewed for 18 HCC patients who underwent hepatic resection with or without splenectomy. Among 581 HCC patients who underwent hepatic resection during the past 17 years, 18 patients with HSTC were investigated. Twelve of them underwent hepatic resection for HCC and had a concomitant splenectomy and the remaining 6 patients underwent hepatic resection for HCC only. The clinical outcomes and postoperative changes in platelet count, serum albumin level, serum total bilirubin levels, prothrombin time and clinical staging (Child-Pugh Classification) were reviewed. The resected spleen mean weight was 350.7+/-102.9 g. Postoperative platelet counts were significantly increased with albumin levels and clinical staging scores also improved after the splenectomy. Among the 12 patients who had a splenectomy, 6 patients had postoperative complications and one died of recurrent variceal bleeding. According to this data, it is not harmful to perform a concomitant splenectomy and hepatectomy for the HCC patient with severe HSTC, it can even be beneficial in improving both the platelet count and clinical staging.
Adult ; Carcinoma, Hepatocellular/*complications/surgery ; Female ; Hepatectomy ; Human ; Hypersplenism/*etiology/*surgery ; Hypertension, Portal/*complications ; Liver Neoplasms/*complications/surgery ; Male ; Middle Aged ; *Splenectomy

OBJECTIVETo investigate the influence of combined hepatectomy with splenectomy on safety of operation for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism and the best peri-operative treatment of these patients.

METHODSClinical data of 177 hepatocellular carcinoma patients complied with cirrhosis and hypersplenism admitted from January 1999 to December 2009 were analyzed retrospectively. Among which, 71 patients received concomitant splenectomy with hepatectomy (splenectomy group), 106 patients only receive a hepatectomy (non-splenectomy group). The safety of operation, complications, liver function and WBC and PLT counts were compared between the two groups.

RESULTSThere was no significant difference of general conditions, counts of WBC and PLT between the two groups before operation. The counts of PLT at 1, 10, 30 day after operation were (88.4 ± 23.6) × 10⁹/L, (345.3 ± 98.2) × 10⁹/L and (210.8 ± 92.2) × 10⁹/L respectively in splenectomy group, which were significantly higher than that of non-splenectomy group (P < 0.05). The operation time of splenectomy group was (216 ± 105) min, which was longer than that of non splenectomy group (P < 0.05), but the blood loss and transfusion rate had not significantly difference between the two groups. The complication rates of splenectomy group and non-splenectomy group were 11.3% and 6.6% respectively, there was no significant difference between the two groups.

CONCLUSIONCombined hepatectomy with splenectomy will be safe for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism as if the operative indication and increase the ability of peri-operative treatment are strictly obeyed.

Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; surgery ; Female ; Hepatectomy ; Humans ; Hypersplenism ; etiology ; surgery ; Liver Cirrhosis ; complications ; Liver Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Splenectomy ; Treatment Outcome

OBJECTIVESTo summarize the experience of surgical intervention for hepatocellular carcinoma (HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis.

METHODSFrom 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.

RESULTSThe operative procedures included hepatectomy with removal of BDT (n = 7), hepatectomy combined with extrahepatic bile duct resection (n = 4), thrombectomy through choledochotomy (n = 3), and piggy-back orthotopic liver transplantation (n = 1). The 1- and 3-year survival rates were 73.3% and 40%, respectively. Two patients survived over 5 year. The survival rate of patients with portal vein invasion was significantly lower than that of patients without portal vein invasion (P < 0.05).

CONCLUSIONSSurgical intervention was effective for patients with HCC and BDT. Operation after recurrence can prolong the survival time. Liver transplantation is a new operative procedure worthy of study.

Adult ; Aged ; Bile Duct Neoplasms ; surgery ; Carcinoma, Hepatocellular ; complications ; surgery ; Female ; Humans ; Liver Neoplasms ; complications ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Thrombosis ; surgery