The Liver Tunnel: Intention-to-treat Validation of a New Type of Hepatectomy

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Abstract

OBJECTIVE: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.

BACKGROUND: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.

METHODS: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.

RESULTS: Twenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma-mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1-37): 79 lesions were included in the LT specimen (median 3; range 1-13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50%) patients: major in 2 (10%). All complications were managed conservatively. After a median 15-month follow-up (range 6-48), 2 instances of cut-edge local recurrences were observed.

CONCLUSIONS: This study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.

Original languageEnglish
JournalAnnals of Surgery
DOIs
Publication statusE-pub ahead of print - Sep 11 2017

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Hepatectomy
Liver
Hepatic Veins
Cholangiocarcinoma
Hepatocellular Carcinoma
Neoplasms
Validation Studies
Veins
Neoplasm Metastasis
Morbidity
Recurrence
Mortality

Cite this

@article{d1ad004b8d7d4dc2a0eb3acc1575b16c,
title = "The Liver Tunnel: Intention-to-treat Validation of a New Type of Hepatectomy",
abstract = "OBJECTIVE: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.BACKGROUND: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.METHODS: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.RESULTS: Twenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma-mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1-37): 79 lesions were included in the LT specimen (median 3; range 1-13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50{\%}) patients: major in 2 (10{\%}). All complications were managed conservatively. After a median 15-month follow-up (range 6-48), 2 instances of cut-edge local recurrences were observed.CONCLUSIONS: This study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.",
author = "Guido Torzilli and Fabio Procopio and Luca Vigan{\`o} and Guido Costa and Andrea Fontana and Matteo Cimino and Matteo Donadon and {Del Fabbro}, Daniele",
year = "2017",
month = "9",
day = "11",
doi = "10.1097/SLA.0000000000002509",
language = "English",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - The Liver Tunnel

T2 - Intention-to-treat Validation of a New Type of Hepatectomy

AU - Torzilli, Guido

AU - Procopio, Fabio

AU - Viganò, Luca

AU - Costa, Guido

AU - Fontana, Andrea

AU - Cimino, Matteo

AU - Donadon, Matteo

AU - Del Fabbro, Daniele

PY - 2017/9/11

Y1 - 2017/9/11

N2 - OBJECTIVE: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.BACKGROUND: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.METHODS: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.RESULTS: Twenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma-mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1-37): 79 lesions were included in the LT specimen (median 3; range 1-13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50%) patients: major in 2 (10%). All complications were managed conservatively. After a median 15-month follow-up (range 6-48), 2 instances of cut-edge local recurrences were observed.CONCLUSIONS: This study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.

AB - OBJECTIVE: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.BACKGROUND: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.METHODS: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.RESULTS: Twenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma-mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1-37): 79 lesions were included in the LT specimen (median 3; range 1-13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50%) patients: major in 2 (10%). All complications were managed conservatively. After a median 15-month follow-up (range 6-48), 2 instances of cut-edge local recurrences were observed.CONCLUSIONS: This study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.

U2 - 10.1097/SLA.0000000000002509

DO - 10.1097/SLA.0000000000002509

M3 - Article

C2 - 28902667

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -