Huang Jiefu

Two-stages resection for advanced hepatocellular carcinoma

We performed two-stage resection for sixteen patients with advanced hepatocellular carcinoma from January, 1987 to July, 1991. All patients underwent various surgical therapies prior to resection which included gauze packing hemostasis in 1 case, hyperthermia plus radiotherapy in 1, hepatic arterial ligation in 2, operative hepatic arterial embolization in 3, and transcatheter embolization in 9. The median interval between the first therapy and tumour resection was 59 days with a range of 29--769 days, and the median diameter of tumours decreased from 10.5 cm to 7.5 cm. The majority of precedures on two-stage resection were irregular hepatectomy or Iobectomy under occlusion of porta hepatis. Regular hepatectomies were done in 4 cases. Pathalogical examination showed complete coagulation necrosis in 3 specimens. However, in the others were still found residual viable tumours. Survival periods of the patients who received two-stage resection were from 4 months to 4 years except 2 operative death. The significance, possibility as well as methods of two-stage resection were discussed.We performed two-stage resection for sixteen patients with advanced hepatocellular carcinoma from January, 1987 to July, 1991. All patients underwent various surgical therapies prior to resection which included gauze packing hemostasis in 1 case, hyperthermia plus radiotherapy in 1, hepatic arterial ligation in 2, operative hepatic arterial embolization in 3, and transcatheter embolization in 9. The median interval between the first therapy and tumour resection was 59 days with a range of 29--769 days, and the median diameter of tumours decreased from 10.5 cm to 7.5 cm. The majority of precedures on two-stage resection were irregular hepatectomy or Iobectomy under occlusion of porta hepatis. Regular hepatectomies were done in 4 cases. Pathalogical examination showed complete coagulation necrosis in 3 specimens. However, in the others were still found residual viable tumours. Survival periods of the patients who received two-stage resection were from 4 months to 4 years except 2 operative death. The significance, possibility as well as methods of two-stage resection were discussed.

The technique of the normothermic and hypothermic total hepatic vascular exclusion for resection of the liver tumors

The technique for bloodless hepatic resection using the total hepatic vascular isolation under the normothermic or hypothermic perfusion was reported to deal with the large liver tumor involving in the liver hilum, the main hepatic veins or the retrohepatic vena cava.The original Heaneys and Fortners methods were modified so that the technique could be simpler and more practicable to perform otherwise hazardous liver resection. During the past 4 year, major hepatic resection with the normothermic or hypothermic total vascular exclusion technique was successfully performed on 19 patients with liver tumors in our department. Among the 19 cases, 16 underwent hepatic resection with the normothermic selective total vascular exclusion (extended right lobectomy in 5 cases, extended left lobectomy in 3 cases; right lobectomy in 5 cases; central segmentectomy in 3 cases) and 3 with the total vascular isolation and in situ cold perfusion (extended left lobectomy in 2 case, extended right lobectong in 1 case). We believe that the technique of normothermic vascular exclusion may be indicated to deal with the lesion close to the hepatic veins and the retrohepatic vena cava. However, for more complicated hepatic resection, the hypothermic perfusion technique should be considered to prolong the safety of ischemic time of the liver. The preliminary experience in the clinical application using the above technique is reported.