Daniel Cherqui

Is the treatment of hepatocellular carcinoma on the waiting list necessary

Pietro Majno, Riccardo Lencioni, Françoise Mornex, Nicolas Girard, Ronnie T. Poon, and Daniel Cherqui Department of Transplantation and Visceral Surgery, University Hospital of Geneva, Geneva, Switzerland; Division of Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplantation, Pisa University Hospital, Pisa, Italy; Department of Radiation Oncology, Lyon-Sud Hospital, Pierre-Bénite, France; Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China; and Hepatobiliary Surgery and Liver Transplantation Section, Department of Surgery, New York–Presbyterian/Weill Cornell Medical Center, New York, NY

An update on laparoscopic liver resection: The French Hepato-Bilio-Pancreatic Surgery Association statement

Laparoscopic liver resection has been recognized as a safe and efficient approach since the Louisville Conference in 2008, but its use still remains confined to experienced teams in specialized centers, and may lack some standardization. The 2013 Session of French Association for Hepatobiliary and Pancreatic Surgery (ACHBT) specifically focused on laparoscopic liver surgery and the particular aspects and issues arising since the 2008 conference. Our objective is to provide an update and summarize the current French position on laparoscopic liver surgery. An overview of the current practice of laparoscopic liver resections in France since 2008 is presented. The issues surrounding standardization for left lateral sectionectomy and right hepatectomy, hybrid and hand-assisted techniques are raised and discussed. Finally, future technologies and technical perspectives are outlined.

Radiofrequency-Assisted Hepatic Resection

BackgroundThe only curative procedure to date for liver tumors is surgical resection, which remains a major procedure with marked morbidity and mortality. Radiofrequency (RF) has increasingly been used for both ablation and resection. On the basis of this technique, a new bipolar RF device, Habib 4X, has been developed and used clinically. We present our technique of liver resection with this device in a patient with colorectal liver metastases.MethodsA patient with situs inversus who had colorectal liver metastases in her left lobe underwent left lateral segmentectomy with the new device, a four-electrode bipolar resection device that uses RF energy for tissue necrosis. After laparotomy and intraoperative ultrasound, the plane resection was marked 1 cm away from the edge of the lesion. Coagulative desiccation was performed along this plane using this sealer connected to a RF generator. The necrosed band of parenchyma was then divided with a scalpel and resection completed.ResultsThe length of the procedure was 105 minutes; resection time was 35 minutes. Total blood loss was 100 ml. No blood transfusions were required, and the patient was not admitted to the intensive care unit after surgery. The patient was discharged 10 days after surgery without any surgical complications.ConclusionsWe think that RF-assisted liver resection with this new device is safe and effective. It is quicker than conventional RF and may reduce overall hospital stay in liver resection patients.

Radiation-induced cholangitis with hepatocellular carcinoma.

There are no reports of hepatocellular carcinoma complicating postradiotherapy cholangitis. We report the case of a 45-year-old patient who had undergone upper abdominal radiotherapy for Hodgkins disease, 21 years before, which was complicated years later by cholangitis with stricture of the common bile duct. Biliodigestive anastomosic surgery was scheduled due to recurrent angiocholitis, and hepatocellular carcinoma was discovered. The patient died from carcinoma some months later.

Laparoscopic Liver Resection for HCC: A European Perspective

Hepatocellular carcinoma (HCC), the most common primary liver cancer, occurs in >90% of the cases on an underlying hepatic disease [1]. Screening programs allow diagnosis at an early stage where curative treatments can be proposed. These include liver resection, percutaneous radiofrequency ablation, and liver transplantation [1, 2]. Even if liver transplantation is the best treatment for early HCC by removing both the tumor and the underlying liver disease, shortage of donor organs and dropout from the waiting list limit its efficacy [3]. In recent years liver resection in cirrhotic patients became safer [4, 5] and achieved a key role in HCC treatment: in advanced tumors it is the only therapeutic option, while in early tumor it can be proposed as an alternative or a bridge to liver transplantation [6–9].

Hepatectomies by Laparoscopic Approach: Intra-Glissonian Approach versus Extra-Glissonian and Posterior Approach

Surgery continues to evolve, and the laparoscopic approach for liver resections is now becoming well established. This chapter outlines three surgical approaches via the laparoscopic route. First is the traditional dissection of structures outside the liver and then two separate accounts of the use of the posterior approach to the hilum of the liver, essentially duplicating techniques which are carried out via the open posterior approach as detailed earlier in this book.

Right Hepatectomy: Laparoscopic Approach

Laparoscopic liver surgery (LLS) has become increasingly common [1, 2]. A recent international position paper maintains that LLS is a safe and effective approach to the management of surgical liver disease in selected patients in the hands of trained surgeons [3]. However, most procedures are limited resections, and only 9% of nearly 3,000 cases reported in the international literature are right hepatectomies [4], as it remains a challenging procedure.

Imagerie du carcinome hépatocellulaire avant transplantation hépatique en 2011 : état de l’art et perspectives

Le carcinome hepatocellulaire (CHC) est la cinquieme tumeur par ordre de frequence dans le monde et la troisieme cause de mortalite liee au cancer apres le cancer pulmonaire et le cancer gastrique. L’imagerie est integree dans les algorithmes decisionnels du diagnostic non invasif des CHC avant transplantation. Tant le scanner multidetecteur, que l’IRM, ou l’echographie avec injection de produit de contraste ultrasonore peuvent etre utilises pour demontrer les profils vasculaires caracteristiques des nodules de CHC avec des performances voisines depassant 80 % d’exactitude. Mais plus encore que la detection et la caracterisation de tous les nodules de CHC avant greffe, les principaux developpements en imagerie concernent l’imagerie dite fonctionnelle avec comme ambition une meilleure caracterisation des lesions agressives, une meilleure evaluation de la reponse therapeutique, et une meilleure stratification des malades.

CO.123 Traitement endoscopique transgastrique de la nécrose pancréatique infectée

Introduction Le traitement des pancreatites necrosantes infectees repose essentiellement sur l’exerese de la necrose habituellement par voie chirurgicale. Quelques equipes ont decrit sur de courtes series leur experience de necrosectomie par voie endoscopique transgastrique ou transduodenale. Nous exposons ici les resultats obtenus dans notre centre. Patients et Methodes Les patients etaient selectionnes pour un traitement endoscopique de la necrose lorsque l’infection de celle-ci etait averee ou fortement suspectee et lorsque la zone necrotique se situait a proximite de l’estomac ( Resultats 7 patients ont ete traites successivement. Quatre en etat de choc septique avaient eu un premier geste de drainage simple endoscopique permettant une stabilisation clinique avant la necrosectomie dans un deuxieme temps. Cinq presentaient une necrose glandulaire (dont un avec extension dans la gouttiere parieto-colique gauche et un avec extension dans la racine du mesentere) et deux une coulee de l’arriere cavite des epiploons. La necrosectomie etait realisee en un temps d’une duree moyenne de 3 heures. Deux a 4 drains en double queue-de-cochon etaient poses. La cavite etait ensuite lavee par serum physiologique en continu pendant 72 h par le drain naso-kystique. Une sphincterotomie biliaire etait realisee en cas de lithiase. Une prothese pancreatique etait posee chez 5 patients pour rupture canalaire. Aucune complication liee au geste ne survenait, ni aucun deces. La duree totale moyenne d’hospitalisation etait de 58 jours dont 30 apres le geste. La duree moyenne d’hospitalisation en reanimation etait de 28 jours dont 21 apres le geste. Les drains etaient definitivement retires apres 6 mois, sans recidive de collection avec un recul moyen de 10 mois. Conclusion Pour des patients selectionnes, le traitement endoscopique de la necrose pancreatique infectee est efficace et participe a la prise en charge multidisciplinaire de ces patients.

Detection des metastases hepatiques : quoi de neuf en 2008 ?

Objectifs Connaitre l’interet et les limites de chaque modalite d’imagerie (echographie, echographie avec injection de produit de contraste ultra-sonore, TDM, IRM, TEP-TDM) dans la detection des lesions secondaires hepatiques. Connaitre l’apport potentiel de l’imagerie fonctionnelle (imagerie de diffusion, de perfusion, imagerie de ciblage) pour le diagnostic precoce des lesions secondaires hepatiques. Points cles La detection et le suivi des lesions secondaires hepatiques reposent sur une approche multi-modalite ou la TDM joue un role central. La combinaison d’une information morphologique et fonctionnelle (perfusion, diffusion, fixation scintigraphique, ciblage) est indispensable pour assurer la detection precoce et le suivi des lesions secondaires hepatiques. Resume La detection de lesions secondaires hepatiques repose principalement sur la TDM, l’IRM et la TEP-TDM. En cas de maladie metastatique limitee au foie, l’objectif est de parvenir a une destruction (chirurgicale, percutanee, medicamenteuse) de l’ensemble des sites metastatiques. Le role de l’imagerie est donc de permettre la detection precoce de l’ensemble des sites metastatiques.