Iswanto Sucandy

Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors

BACKGROUND We aim to investigate long-term survival outcomes in patients undergoing radiofrequency ablation (RFA), based on our longitudinal 5 and 10 year follow-up data. METHODS All patients who underwent RFA for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CLM) between 1999 and 2010. RESULTS 320 patients were included with oncologic diagnoses of HCC in 122 (38.1%) and CLM in 198 (61.9%). The majority of patients had a single tumor ablation (71% RFA 1 lesion). Minimum 5 year follow-up information was available in 89% patients, with a median follow-up of 115.3 months. In patients with HCC, disease eventually recurred in 73 (64%) patients. In patients with CLM, disease recurrence was ultimately seen in 143 (84.1%) patients. In the HCC group, the 5- and 10-year overall survivals were 38.5% and 23.4%, while in the CLM group, the 5- and 10-year overall survivals were 27.6% and 15%, respectively. CONCLUSIONS The use of RFA as a part of treatment strategy for primary and metastatic liver tumors imparts 10-year overall survivals of >23% and 15%, respectively. This study indicates that long-term survival is possible with RFA treatment.

Evidence supporting laparoscopic major hepatectomy

Laparoscopic liver resection (LLR) has been increasing in frequency with over 9,000 cases done worldwide. Benefits of laparoscopic resection include less blood loss, smaller incisions, decreased postoperative morbidity, and shorter length of stay compared to open liver resection. With increased experience, several centers have reported series of laparoscopic major hepatectomy, although this represents only about 25% of total LLR performed. Evidence is accumulating to support laparoscopic major hepatectomy with the understanding that there is a steep learning curve, and surgeons should begin with minor LLR before moving on to laparoscopic major hepatectomy. Controversy still remains concerning indications, techniques, learning curve, risks, and long‐term cancer outcomes with laparoscopic major hepatectomy.

Indications and outcomes of pancreatic surgery after liver transplantation

Prior liver transplantation and immunosuppression potentially translate into significant morbidity and poor outcomes after any type of pancreatic surgery. Little is known about the outcomes of pancreatic surgery after liver transplantation. This study was designed to review our experience regarding the indications and outcomes of pancreatic surgery following liver transplantation.

Minimally Invasive Techniques of Hepatic Resection

Abstract As liver resection becomes safer and experience in minimal access surgery accumulates, minimally invasive hepatectomy is gaining in popularity. Reduced postoperative pain, decreased postoperative narcotic requirement, decreased length of hospital stay, lower wound-related complications, and improved cosmesis have transformed minimally invasive liver resection to become the preferred approach when technically feasible. In recent years, minimally invasive major hepatectomy is increasingly performed worldwide, especially at major hepatobiliary centers. More hepatobiliary surgeons are interested in embracing laparoscopic or robotic liver resection in an effort to improve patient results. Herein, we describe outcomes, technical approaches, and current literature relating to minimally invasive hepatic resection.

Robotic Liver Resection and Biliary Reconstruction

Robotic assistance offers several advantages for certain surgical procedures. Its use is being investigated for its application in hepatobiliary surgery. This chapter describes techniques for various robotic-assisted liver resections and biliary surgery.

Minimally Invasive Hepatic Resection

As morbidity and mortality after liver resection decrease and experience in minimally invasive technique increases, laparoscopic hepatectomy began to gain popularity. Less postoperative pain, decreased narcotic requirement, shorter length of hospital stay, lower wound-related complications, and better cosmesis have transformed minimally invasive liver resection to become the preferred approach whenever technically feasible. In the last several years, minimally invasive major hepatectomy is increasingly performed worldwide, especially at major academic hepatobiliary centers. More hepatobiliary surgeons are interested in embracing laparoscopic or robotic liver resection in an effort to improve patient outcomes. In this chapter, we describe laparoscopic and robotic techniques in hepatic resection.

Technique and initial results of fully robotic left hepatectomy for malignant tumor: an alternative minimally invasive method to the laparoscopic approach

Hepatic resections are widely performed for both benign and malignant liver pathology. Outcomes of hepatic resection have improved in the last decade with better understanding of liver anatomy, advancement in surgical instrumentation, improved anesthesia care, and better perioperative patient management (1).

Hand-assisted laparoscopic left hepatectomy: how I do it

Laparoscopic liver resection has been adopted slowly due to concerns for bleeding and oncologic outcomes. Currently, over 9,500 laparoscopic liver resections have been performed and reported worldwide. Numerous studies have shown the safety and oncologic equivalence of laparoscopic liver resection when compared to open resection. Pure laparoscopic and hand‐assisted laparoscopic liver resection are the two most commonly used techniques for minimally invasive liver resection surgery. Advantages of the hand‐port include tactile feedback, facilitation of liver mobilization, and ease of ability to control bleeding. We present a case report with video of a hand‐assisted laparoscopic left liver resection for a hepatocellular carcinoma in a non‐cirrhotic patient.