Abstract: Objective:To investigate the clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline.
Methods:The retrospective and descriptive study was conducted. The clinical data of 22 patients who underwent precise resection of liver tumors adjacent to the main pipeline in the Affiliated Tumor Hospital of Zhengzhou University between December 2014 and June 2016 were collected. According to preoperative precise evaluation and fully intraoperative exposed tumors, different methods of blood flow occlusion were choosed timely, and then precise resection of the liver was evaluated based on tumor location and size, relationship between tumor and blood vessels and the degree of liver cirrhosis. The operation procedures, operation time, time of liver resection, volume of intraoperative blood loss, number of patients with perioperative blood transfusion, postoperative complications, duration of postoperative hospital stay and followup were observed. The followup was performed by outpatient examination and telephone interview up to September 2016. Tumor recurrence of patients with hepatocellular carcinoma (HCC) was monthly detected by alphafetoprotein retest and color Doppler ultrasound of the liver or computed tomography (CT) within 3 months postoperatively. Tumor recurrence of patients with cholangiocarcinoma was monthly detected by tumor marker retests, color Doppler ultrasound of the liver or CT, and then patients without tumor recurrence received reexamination once every 2 months after 3 months. Patients with liver hemangioma were followed up once every 2-3 months and once every 6 months after half a year, and followup included the liver function, ultrasound and other imaging examinations to detect the tumor recurrence. Measurement data with normal distribution were represented as ±s.
Results:All the 22 patients underwent successful precise resection of liver tumors. Twenty patients received intraoperative ultrasound localization. Blood flow occlusion of 22 patients: Pringle was conducted in 6 patients, treatment of the corresponding hepatic pedicle in 3 patients, selective hepatic blood flow occlusion in 8 patients, total hepatic blood flow occlusion in 2 patients and nonhepatic portal occlusion in 3 patients. Precise resection of the liver of 22 patients: 1 patient underwent right trisegmentectomy, 2 underwent left hepatectomy, 2 underwent segment Ⅳa resection of the liver, 2 underwent segment Ⅳ resection of the liver, 3 underwent segment Ⅴ resection of the liver, 3 underwent segment Ⅷ resection of the liver, 1 underwent middle lobe resection of the liver and 8 underwent partial resection of the liver. Operation time, time of liver resection, volume of intraoperative blood loss and number of patients with perioperative blood transfusion were (213±39)minutes, (57±19)minutes, (518± 98)mL and 3, respectively. Of 22 patients, 5 with postoperative complications were improved after symptomatic treatment, including 2 with effusion at surgical site, 2 with right pleural effusion and 1 with bile leakage. The duration of postoperative hospital stay of 22 patients was (8.9±1.6)days. Twentyone patients were followed up for 3-20 months, with a median time of 12 months. Two of 22 patients had recurrence during the followup, and no recurrence at surgical site was detected.
Conclusion:Precise resection of liver tumors adjacent to the first and second hepatic hilum is safe and feasible, with the advantages of less intraoperative bleeding and low incidence of postoperative complications.