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Hepatectomy for hepatocellular carcinoma in the era of liver transplantation

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World Journal of Gastroenterology 2014年第28期20卷 9237-9244页

作者： Wen-Ping Lu jia-hong dong Institute of Hepatobiliary Surgery Chinese PLA General Hospital

The aim of management of hepatocellular carcinoma(HCC)is to improve the prognosis of the patients by radical resection and preserve remnant liver *** liver transplantation is associated with a lower tumor recurrence rate,this benefit is counteracted by long-term ***,hepatectomy could be the first choice of treatment in selected patients with ***,the higher frequency of tumor recurrence and the lower rate of resectability after hepatectomy for HCC led to an unsatisfactory *** strategies are required to improve the long-term outcome of HCC after *** this paper,we introduce some strategies to increase the low rate of resectability and reduce the high rate of tumor *** aggressive treatments for tumor recurrence to extend long-term survival are also *** believe that hepatectomy combined with other therapies,such as portal vein embolization,transarterial chemoembolization,radioembolization,antiviral treatment,radiofrequency ablation and salvage transplantation,is a promising treatment modality for HCC and may improve survival greatly.

关键词： Hepatocellular carcinoma Hepatectomy Prognosis

Hepatocellular Carcinoma with Blood Supply from Parasitized Omental Artery: Angiographic Appearance And Chemoembolization

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Chinese Journal of Cancer Research 2012年第3期24卷 207-212页

作者： Song Gao Ren-jie Yang jia-hong dong Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Interventional Therapy Department Peking University Cancer Hospital & Institute Beijing 200142 China Department of Hepatobiliary Surgery the General Hospital of the People's Liberation Army Beijing 100853 China

Objective： To analyze angiographic appearance of hepatocellular carcinoma （HCC） with blood supply from parasitized omental artery （POA）, and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. Methods： A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. Results： Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was：（1） hypertrophic POAs participating in tumor staining （n=28）; （2） stiff and distorted POA （n=11）, displaced due to tumor＇s oppression （n=8）; and （3） defective tumor staining close to either gastrocolic omentum distribution or liver capsule （n=7）. In 19 patients, chemoembolization via POAs was performed successfully （A group）, while the remaining 13 patients failed （B group）. Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. Conclusion： Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.

关键词： Hepatocellular carcinoma Omentat artery Angiography Chemoembotization

Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach： a single-center experience with 305 patients

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 271-278页

作者： Xue-dong Wang hong-Guang Wang Jun Shi Wei-dong Duan Ying Luo Wen-Bin Ji Ning Zhang jia-hong dong Department of Hepatobiliary Surgery Beijing Tsinghua Changgung Hospital Medical Center Tsinghua University Beijing 102218 China Hospital and Institute of Hepatobiliary Surgery Chinese PLA General Hospital Beijing 100853 China

BACKGROUND： Decision making and surgical planning are to achieve the precise balance of maximal removal of target lesion, maximal sparing of functional liver remnant volume, and minimal surgical invasiveness and therefore, crucial in liver surgery. The aim of this prospective study was to validate the accuracy and predictability of 3D interactive quantitative surgical planning approach （IQSP）, and to evaluate the impact of IQSP on traditional surgical plans based on 2D images. METHODS： A total of 305 consecutive patients undergoing hepatectomy were included in this study. Surgical plans were created by traditional 2D approach using picture archiving and communication system （PACS） and 3D approach using IQSP respectively by two groups of physicians who did not know the surgical plans of the other group. The two surgical plans were submitted to the chief surgeon for selection before operation. The specimens were weighed. The two surgical plans were compared and analyzed retrospectively based on the operation results. RESULTS： The two surgical plans were successfully developed in all 305 patients and all the 3D IQSP surgical plans were selected as the final decision. Total 278 patients successfully underwent surgery, including 147 uncomplex hepatectomy and 131 complex hepatectomy. Twenty-seven patients were withdrawn from hepatectomy. In the uncomplex group, the two surgical plans were the same in all 147 patients and no statistically significant difference was found among 2D calcu- lated resection volume （2D-RV）, 3D IQSP calculated resection volume （IQSP-RV） and the specimen volume. In the complex group, the two surgical plans were different in 49 patients （49/131, 37.4%）. According to the significance of differences, the 49 different patients were classified into three grades. No statistically significant difference was found between IQSP-RV and specimen volume. The coincidence rate of territory analy- sis of IQSP with operation was 92.1% （93/101） for 101 patients of

关键词： precision quantitative surgical planning reconstruction hepatectomy

Dual liver transplantation

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2013年第3期14卷 178-184页

作者： Hao CHEN Ying ZHANG Yong-mei HAN Emmanue HUGUET dong-sheng HUANG jia-hong dong Hepatobiliary Surgery Hospital and Institute of Chinese People's Liberation Army(PLA) General Hospital Division of Cardiology Department of MedicineCollege of MedicineUniversity of Florida Department of Microbiology Chinese PLA General Hospital Department of General Practice Sir Run Run Shaw HospitalCollege of MedicineZhejiang University Department of General Surgery National Institute for Health Research(NIHR) Comprehensive Biomedical CampusAddenbrookes Hospital Department of General Surgery Zhejiang Provincial People's Hospital

Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction(STEMI) care,and it is *** the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in *** need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI *** article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.

关键词：外科学手术器官移植术医学

Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies

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Hepatobiliary & Pancreatic Diseases International 2014年第1期13卷 10-17页

作者： Ying Luo Wen-Bin Ji Wei-dong Duan Sheng Ye jia-hong dong Department of Hepatobiliary Surgery Chinese PLA General Hospital

BACKGROUND: Graft cholangiopathy has been recognized as a significant cause of morbidity, graft loss, and even mortality in patients after orthotopic liver transplantation. The aim of this review is to analyze the etiology, pathogenesis, diagnosis and therapeutic strategies of graft cholangiopathy after liver transplantation. DATA SOURCE: A PubMed database search was performed to identify articles relevant to liver transplantation, biliary complications and cholangiopathy. RESULTS: Several risk factors for graft cholangiopathy after liver transplantation have been identified, including ischemia/ reperfusion injury, cytomegalovirus infection, immunological injury and bile salt toxicity. A number of strategies have been attempted to prevent the development of graft cholangiopathy, but their efficacy needs to be evaluated in large clinical studies. Non-surgical approaches may offer good results in patients with extrahepatic lesions. For most patients with complex hilar and intrahepatic biliary abnormalities, however, surgical repair or re-transplantation may be required. CONCLUSIONS: The pathogenesis of graft cholangiopathy after liver transplantation is multifactorial. In the future, more efforts should be devoted to the development of more effective preventative and therapeutic strategies against graft cholangiopathy.

关键词： liver transplantation bile ducts complications ischemia/reperfusion injury therapy

Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy

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World Journal of Gastroenterology 2016年第34期22卷 7797-7805页

作者： Bing-Yang Hu Tao Wan Wen-Zhi Zhang jia-hong dong Institute and Hospital of Hepatobiliary Surgery Chinese PLA General HospitalBeijing 100853China Hepato-Pancreato-Biliary Center Beijing Tsinghua Changgung HospitalBeijing 102218 China

AIM To analyze the risk factors for pancreatic fistula after *** We conducted a retrospective analysis of 539 successive cases of pancreaticoduodenectomy performed at our hospital from March 2012 to October 2015. Pancreatic fistula was diagnosed in strict accordance with the definition of pancreatic fistula from the International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression *** A total of 269(49.9%) cases of pancreatic fistula occurred after pancreaticoduodenectomy,including 71(13.17%) cases of grade A pancreatic fistula,178(33.02%) cases of grade B,and 20(3.71%) cases of grade C. Univariate analysis showed no significant correlation between postoperative pancreatic fistula(POPF) and the following factors: age,hypertension,alcohol consumption,smoking,history of upper abdominal surgery,preoperative jaundice management,preoperative bilirubin,preoperative albumin,pancreatic duct drainage,intraoperative blood loss,operative time,intraoperative blood transfusion,Braun anastomosis,and pancreaticoduodenectomy(with or without pylorus preservation). Conversely,a significant correlation was observed between POPF and the following factors: gender(male vs female: 54.23% vs 42.35%,P = 0.008),diabetes(non-diabetic vs diabetic: 51.61% vs 39.19%,P = 0.047),body mass index(BMI)(≤ 25 vs > 25: 46.94% vs 57.82%,P = 0.024),blood glucose level(≤ 6.0 mmol/L vs > 6.0 mmol/L: 54.75% vs 41.14%,P = 0.002),pancreaticojejunal anastomosis technique(pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-tomucosa anastomosis: 57.54% vs 35.46%,P = 0.000),diameter of the pancreatic duct(≤ 3 mm vs > 3 mm: 57.81% vs 38.36%,P = 0.000),and pancreatic texture(soft vs hard: 56.72% vs 29.93%,P = 0.000). Multivariate logistic regression analysis showed that gender(male),BMI > 25,pancreatic duct

关键词： Pancreaticoduodenectomy Pancreatic fistula Pancreaticojejunal anastomosis Pancreatic duct Complications

Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods

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Hepatobiliary & Pancreatic Diseases International 2018年第2期17卷 101-112页

作者： Rui Tang Long-Fei Ma Zhi-Xia Rong Mo-Dan Li jian-Ping Zeng Xue-dong Wang hong-En Liao jia-hong dong Department of Hepatopancreatobiliary Surgery Beijing Tsinghua Changgung Hospital School of Clinical Medicine No.168 Litang Road Changping DistrictTsinghua University Department of Biomedical Engineering School of Medicine Tsinghua University Service de Chirurgie Hépatobiliaire Pancréatique et de Transplantation Hépatique Centre Hospitalier de l'Université de Montréal(CHUM) Université de Montréal

Background: Augmented reality(AR) technology is used to reconstruct three-dimensional(3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical *** Sources: The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the Pub Med database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key ***: In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery,which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR ***: With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling,and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods.

关键词： Augmented reality Image-guided surgery Liver surgery 3D technology

Comprehensive application of modern technologies in precise liver resection

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 244-250页

作者： Nian-Song Qian Yong-Hui Liao Shou-Wang Cai Vikram Raut jia-hong dong Department of Hepatobiliary Surgery PLA General Hospital Department of Hepatobiliary Surgery Hainan Branch of PLA General Hospital Department of Anatomy Fourth Military Medical University Department of Hepatobiliary Surgery Graduate School of Medicine Kyoto University

BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA SOURCE: PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is ***: Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large rand

关键词： precise liver resection anatomy parenchyma transection down-staging treatment

Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy

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World Journal of Gastroenterology 2014年第46期20卷 17491-17497页

作者： Qi-Yu Liu Wen-Zhi Zhang hong-Tian Xia jian-Jun Leng Tao Wan Bin Liang Tao Yang jia-hong dong Department of Hepatobiliary Surgery the First People’s Hospital of Kunming Department of Hepatobiliary Surgery Chinese People’s Liberation Army General Hospital

AIM: To explore the morbidity and risk factors of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy.

关键词： Pancreaticoduodenectomy Pancreatic fistula Complication Pancreatic duct