Preliminary experience of surgical treatment for hepatic hilar tumor invaded the second and the third hepatic portal_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Yamin , CUI Zilin , LI Yang , WANG Lianjiang , HOU Jiancun , SHI Rui , LIU Zirong

Department of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin 300192, P. R. China;

Corresponding author：

ZHANG Yamin, Email: zhangyamin@medmail.com.cn

Keywords：

liver neoplasm; the second hepatic portal; the third hepatic portal; liver resection; preliminary experience

DOI：

10.7507/1007-9424.201706128

Video：

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Objective To evaluate the safety and efficacy of surgical resection for the second and the third hepatic portal tumor. Methods The clinical data of 39 patients who underwent surgical resection of the second and the third hepatic portal tumor were analyzed from May 2012 to May 2017 in our hospital. Among them, there were 29 patients with primary liver cancer, 6 patients with hepatic hemangioma, 2 patients with focal liver hyperplasia, and 2 patients with liver metastasis from colon cancer. Results Right liver resection was performed in 11 patients, left liver resection in 7 patients, left outer lobe resection in 6 patients, right trefoil excision in 5 patients, Ⅴand Ⅷ segment resection in 4 patients, Ⅶ and Ⅷ segment resection in 4 patients, local resection in 2 patients. In the resection, there were 16 patients without interruption of hepatic inflow, 21 patients with interrupted portal blood flow, 2 patients with total hepatic blood flow occlusion. The operative time of the 39 patients was 150–270 min (mean of 190 min), the intraoperative blood loss was 100–2 000 mL (mean of 680 mL). Postoperative bile leakage occurred in 2 patients, bleeding occurred in 1 patient, and no liver failure occurred. Twenty-six patients were followed-up of 31 liver cancer patients, and the follow-up time was 3–40 months, the median time was 8 months. During follow-up period, 12 patients died, 9 patients died of tumor recurrence, 3 patients died from liver failure. Of 8 patients, 5 patients with benign liver disease were followed-up for 7–18 months with living healthy, and the median time was 9 months. Conclusion The risk of surgical resection of tumors invaded the second and the third hepatic portal is mainly the accurate functional assessment of residual liver and the correct treatment of the main branches of the hepatic veins.

Citation： ZHANG Yamin, CUI Zilin, LI Yang, WANG Lianjiang, HOU Jiancun, SHI Rui, LIU Zirong. Preliminary experience of surgical treatment for hepatic hilar tumor invaded the second and the third hepatic portal. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1062-1065. doi: 10.7507/1007-9424.201706128 Copy

1.	林浩铭, 许磊波, 刘超. 肝癌合并下腔静脉侵犯的诊断与治疗. 肝胆外科杂志, 2015, 23(1): 3-6.
2.	Hemming AW, Reed AI, Langham MR, et al. Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg, 2002, 235(6): 850-858.
3.	邬涛, 严律南, 罗艳丽. 肝切除术后静脉血栓栓塞症影响因素及预防的研究进展. 中国普外基础与临床杂志, 2017, 24(7): 895-899.
4.	Cheng S, Yang J, Shen F, et al. Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus—Eastern Hepatobiliary Surgical Hospital consensus statement. Oncotarget, 2016, 7(26): 40816-40829.
5.	Kokudo T, Hasegawa K, Yamamoto S, et al. Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis. J Hepatol, 2014, 61(3): 583-588.
6.	Liu J, Wang Y, Zhang D, et al. Comparison of survival and quality of life of hepatectomy and thrombectomy using total hepatic vascular exclusion and chemotherapy alone in patients with hepatocellular carcinoma and tumor thrombi in the inferior vena cava and hepatic vein. Eur J Gastroenterol Hepatol, 2012, 24(2): 186-194.
7.	李爱军, 吴孟超, 周伟平, 等. 侵犯下腔静脉的肝脏恶性肿瘤手术治疗. 中华医学杂志, 2006, 86(24): 1671-1674.
8.	Itoh A, Sadamori H, Yabushita K, et al. Advanced hepatocellular carcinoma with hepatic vein tumor thrombosis and renal dysfunction after hepatic arterial infusion chemotherapy effectively treated by liver resection with active veno-venous bypass: report of a case. BMC Cancer, 2016, 16: 705.
9.	Kasai Y, Hatano E, Seo S, et al. Proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava tumor thrombus incorporating hepatic arterial infusion chemotherapy. Surgery, 2017, 10(17): 30337-30339.
10.	Katagiri S, Yamamoto M. Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus. Surg Today, 2014, 44(2): 219-226.
11.	Yoon YS, Han HS, Cho JY, et al. Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery, 2013, 153(4): 502-509.
12.	Arii S, Teramoto K, Kawamura T, et al. Significance of hepatic resection combined with inferior vena cava resection and its reconstruction with expanded polytetrafluoroethylene for treatment of liver tumors. J Am Coll Surg, 2003, 196(2): 243-249.
13.	Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology, 2016, 150(4): 835-853.
14.	耿小平. 肝血管瘤与精准外科治疗. 中国普外基础与临床杂志, 2016, 23(2): 137-139.
15.	Kudo M, Izumi N, Ichida T, et al. Report of the 19^th follow-up survey of primary liver cancer in Japan. Hepatol Res, 2016, 46(5): 372-390.
16.	Shimagaki T, Yoshizumi T, Itoh S, et al. Liver resection with right hepatic vein reconstruction using the internal jugular vein: a case report. Surg Case Rep, 2016, 2(1): 132.
17.	陆崇德, 傅晓辉, 储开建, 等. 原发性肝癌合并下腔静脉癌栓的手术治疗. 现代生物医学进展, 2011, 11(14): 2756-2758.
18.	Ali MA, Chuang JF, Yong CC, et al. Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2015, 14(1): 63-68.
19.	Shimizu A, Kobayashi A, Yokoyama T, et al. Hepatectomy preserving drainage veins of the posterior section for liver malignancy invading the right hepatic vein: an alternative to right hepatectomy. Am J Surg, 2012, 204(5): 717-723.
20.	Tsang J, Chan A, Chok K, et al. Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2017, 16(3): 329-333.
21.	Surjan RC, Basseres T, Pajecki D, et al. A novel technique for hepatic vein reconstruction during hepatectomy. J Surg Case Rep, 2016, 13(4): 1-4..
22.	Ochiai T, Ishii H, Toma A, et al. Modified high dorsal procedure for performing isolated anatomic total caudate lobectomy (with video). World J Surg Oncol, 2016, 14: 132.
23.	Azoulay D, Pascal G, Salloum C, et al. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg, 2013, 100(13): 1764-1775.
24.	朱小东, 孙惠川. 早期肝癌的治疗. 中华肝脏病杂志, 2017, 25(5): 333-335.
25.	Ko S, Kirihataya Y, Matsumoto Y, et al. Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection. World J Hepatol, 2016, 8(8): 411-420.
26.	Pamecha V, Sasturkar SV, Sinha PK, et al. Major liver resection for large and locally advanced hepatocellular carcinoma. Indian J Surg, 2017, 79(4): 326-331.

1. 林浩铭, 许磊波, 刘超. 肝癌合并下腔静脉侵犯的诊断与治疗. 肝胆外科杂志, 2015, 23(1): 3-6.
2. Hemming AW, Reed AI, Langham MR, et al. Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg, 2002, 235(6): 850-858.
3. 邬涛, 严律南, 罗艳丽. 肝切除术后静脉血栓栓塞症影响因素及预防的研究进展. 中国普外基础与临床杂志, 2017, 24(7): 895-899.
4. Cheng S, Yang J, Shen F, et al. Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus—Eastern Hepatobiliary Surgical Hospital consensus statement. Oncotarget, 2016, 7(26): 40816-40829.
5. Kokudo T, Hasegawa K, Yamamoto S, et al. Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis. J Hepatol, 2014, 61(3): 583-588.
6. Liu J, Wang Y, Zhang D, et al. Comparison of survival and quality of life of hepatectomy and thrombectomy using total hepatic vascular exclusion and chemotherapy alone in patients with hepatocellular carcinoma and tumor thrombi in the inferior vena cava and hepatic vein. Eur J Gastroenterol Hepatol, 2012, 24(2): 186-194.
7. 李爱军, 吴孟超, 周伟平, 等. 侵犯下腔静脉的肝脏恶性肿瘤手术治疗. 中华医学杂志, 2006, 86(24): 1671-1674.
8. Itoh A, Sadamori H, Yabushita K, et al. Advanced hepatocellular carcinoma with hepatic vein tumor thrombosis and renal dysfunction after hepatic arterial infusion chemotherapy effectively treated by liver resection with active veno-venous bypass: report of a case. BMC Cancer, 2016, 16: 705.
9. Kasai Y, Hatano E, Seo S, et al. Proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava tumor thrombus incorporating hepatic arterial infusion chemotherapy. Surgery, 2017, 10(17): 30337-30339.
10. Katagiri S, Yamamoto M. Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus. Surg Today, 2014, 44(2): 219-226.
11. Yoon YS, Han HS, Cho JY, et al. Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery, 2013, 153(4): 502-509.
12. Arii S, Teramoto K, Kawamura T, et al. Significance of hepatic resection combined with inferior vena cava resection and its reconstruction with expanded polytetrafluoroethylene for treatment of liver tumors. J Am Coll Surg, 2003, 196(2): 243-249.
13. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology, 2016, 150(4): 835-853.
14. 耿小平. 肝血管瘤与精准外科治疗. 中国普外基础与临床杂志, 2016, 23(2): 137-139.
15. Kudo M, Izumi N, Ichida T, et al. Report of the 19^th follow-up survey of primary liver cancer in Japan. Hepatol Res, 2016, 46(5): 372-390.
16. Shimagaki T, Yoshizumi T, Itoh S, et al. Liver resection with right hepatic vein reconstruction using the internal jugular vein: a case report. Surg Case Rep, 2016, 2(1): 132.
17. 陆崇德, 傅晓辉, 储开建, 等. 原发性肝癌合并下腔静脉癌栓的手术治疗. 现代生物医学进展, 2011, 11(14): 2756-2758.
18. Ali MA, Chuang JF, Yong CC, et al. Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2015, 14(1): 63-68.
19. Shimizu A, Kobayashi A, Yokoyama T, et al. Hepatectomy preserving drainage veins of the posterior section for liver malignancy invading the right hepatic vein: an alternative to right hepatectomy. Am J Surg, 2012, 204(5): 717-723.
20. Tsang J, Chan A, Chok K, et al. Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2017, 16(3): 329-333.
21. Surjan RC, Basseres T, Pajecki D, et al. A novel technique for hepatic vein reconstruction during hepatectomy. J Surg Case Rep, 2016, 13(4): 1-4..
22. Ochiai T, Ishii H, Toma A, et al. Modified high dorsal procedure for performing isolated anatomic total caudate lobectomy (with video). World J Surg Oncol, 2016, 14: 132.
23. Azoulay D, Pascal G, Salloum C, et al. Vascular reconstruction combined with liver resection for malignant tumours. Br J Surg, 2013, 100(13): 1764-1775.
24. 朱小东, 孙惠川. 早期肝癌的治疗. 中华肝脏病杂志, 2017, 25(5): 333-335.
25. Ko S, Kirihataya Y, Matsumoto Y, et al. Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection. World J Hepatol, 2016, 8(8): 411-420.
26. Pamecha V, Sasturkar SV, Sinha PK, et al. Major liver resection for large and locally advanced hepatocellular carcinoma. Indian J Surg, 2017, 79(4): 326-331.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary experience of surgical treatment for hepatic hilar tumor invaded the second and the third hepatic portal

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