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From minimal to maximal surgery in the treatment of hepatocarcinoma:A review

World Journal of Hepatology 2015年第1期7卷 93-100页

作者： Marcos Vinicius Perini graham.starkey Michael A Fink Ramesh Bhandari Vijayaragavan Muralidharan Robert Jones Christopher Christophi Department of Surgery University of MelbourneHeidelbergVIC 3084Australia

Hepatocellular carcinoma represents one of the most challenging frontiers in liver surgery. Surgeons have to face a broad spectrum of aspects,from the underlying liver disease to the new surgical techniques. Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function witha 5-year survival rate of 50%,offering good longterms results in selected patients. With the advances in laparoscopic surgery,major liver resections can be performed with minimal harm,avoiding the wound and leak complications related to the laparotomies. Studies have shown that oncological margins are the same as in open surgery. In patients submitted to liver resection(either laparoscopic or open) who experience recurrence,re-resection or salvage liver transplantation has been showing to be an alternative approach in well selected cases. The decision making approach to the cirrhotic patient is becoming more complex and should involve hepatologists,liver surgeons,radiologists and oncologists. Better understanding of the different risk factors for recurrence and survival should be aimed in these multidisciplinary discussions. We here in discuss the hot topics related to surgical risk factors regarding the surgical treatment of hepatocellular carcinoma: anatomical resection,margin status,macrovascular tumor invasion,the place of laparoscopy,salvage liver transplantation and liver transplantation.

关键词： Hepatectomy Liver resection Cirrhosis Liver transplantation Hepatocellular carcinoma Survival

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Outcomes of central hepatectomy versus extended hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2019年第3期18卷 249-254页

作者： Jenny Chan Luke Bradshaw Nezor Houli Laurence Weinberg Marcos V Perini Michael Fink Vijayaragavan Muralidharan graham.starkey Robert Jones Bao Zhong Wang Christopher Christophi Mehrdad Nikfarjam Department of Surgery University of Melbourne Austin Health Heidelberg Melbourne Victoria Australia Department of Surgery University of Melbourne Northern Health Epping Victoria Australia Department of Anaesthesia University of Melbourne Austin Health Heidelberg Melbourne Victoria Australia

Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four(16.7%) in the EH group( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min(290–840) vs. 523 min(310–860), P = 0.328], intraoperative blood loss [850 mL(40 0–150 0) vs. 650 mL(10 0–20 0 0), P = 0.746] or patients requiring intraoperative blood transfusion [1(9.1%) vs. 7(30.4%), P = 0.227]. There was a trend towards fewer hepatectomyspecific complications in the CH group [3(27.3%) vs. 13(54.2%), P = 0.167], including PHLF(CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days(5–23) vs. 12 days(4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.

关键词： Central hepatectomy Mesohepatectomy Central bisectionectomy Central bisegmentectomy Extended hepatectomy

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Epidemiology and outcomes of acute liver failure in Australia

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World Journal of Hepatology 2019年第7期11卷 586-595页

作者： Penelope Hey Timothy P Hanrahan Marie Sinclair Adam G Testro Peter W Angus Adam Peterson Stephen Warrillow Rinaldo Bellomo Marcos V Perini graham.starkey Robert M Jones Michael Fink Tess McClure Paul Gow Liver Transplant Unit Austin HealthHeidelberg 3084Australia The University of Melbourne Melbourne 3052Australia Department of Intensive Care Austin HeathMelbourne 3084Australia Department of Surgery Austin HealthMelbourne 3084Australia

BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain. AIM To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia. METHODS The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988- 2001. RESULTS Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively. CONCLUSION Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.

关键词： Liver failure Acute Paracetamol Australia Victoria Liver transplant

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