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Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 337-342页

作者： Nobuhiko Kurata Yasuhiro Ogura satoshi ogiso Yasuharu Onishi Hideya Kamei Yasuhiro Kodera Department of Transplantation and Endocrine Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan Department of Transplantation Surgery Nagoya University Hospital65 Tsurumai-choShowa-kuNagoya 466-8560Japan Department of Gastroenterological Surgery(Surgery II) Nagoya University Graduate School of MedicineNagoyaJapan

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in ***,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy ***:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively *** applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or ***,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after *** was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy ***:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup *** should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of *** splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

关键词： Living donor liver transplantation Splenectomy Portal venous pressure Graft-to-recipient weight ratio Portal vein thrombosis

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Cholangiocarcinoma after flow diversion surgery for congenital biliary dilatation: A case report and review of literature

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World Journal of Hepatology 2019年第11期11卷 743-751页

作者： Ryo Ataka Takashi Ito Toshihiko Masui Satoru Seo Takamichi Ishii satoshi ogiso Shintaro Yagi Kojiro Taura Shinji Uemoto Department of Hepato-Biliary-Pancreatic Surgery and Transplantation Graduate School of Medicine Kyoto University

BACKGROUND Pancreaticobiliary maljunction(PBM)can be classified into two categories,PBM with congenital biliary dilatation(CBD)or PBM without biliary dilatation,and the management of PBM is often *** treatment for PBM with CBD is prophylactic flow diversion surgery,and some authors have reported that the incidence of cancer after extrahepatic bile duct excision is less than 1%.A very rare case of intrahepatic cholangiocarcinoma 6 years after flow diversion surgery for PBM with CBD is *** SUMMARY A 30-year-old man was diagnosed as having PBM with CBD,Todani classification type IVA,because of abnormal liver enzyme *** underwent flow diversion surgery and cholecystectomy,and the specimen showed adenocarcinoma foci,pT1,pStage *** and a half years passed without any recurrence of bile duct ***,6 years after his operation,computed tomography showed a gradually growing nodule in the bile *** positron emission tomography showed high uptake,and magnetic resonance imaging showed restricted diffusion *** double balloon enteroscopy,the nodule at the posterior bile duct-jejunum anastomosis was directly visualized,and its biopsy specimen showed *** patient underwent right lobectomy and biliary *** pathological diagnosis was intraductal papillary neoplasm with high-grade intraepithelial neoplasia,pTis,pN0,pStage *** patient’s postoperative course was uneventful,and he has had no recurrence up to the present *** This case suggests the necessity of careful observation after flow diversion surgery,especially when PBM with CBD is detected in adulthood.

关键词： Congenital biliary dilatation Pancreaticobiliary maljunction Cholangiocarcinoma Recurrence Metachronous neoplasm Case report

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Laparoscopic liver resection: Toward a truly minimally invasive approach

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World Journal of Gastrointestinal Endoscopy 2015年第3期7卷 159-161页

作者： satoshi ogiso Etsuro Hatano Takeo Nomi Shinji Uemoto Division of Hepato-Biliary-Pancreatic Surgery and Transplantation Department of Surgery Graduate School of Medicine Kyoto University Department of Surgery Nara Medical University

In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomyin case of intrahepatic recurrence. Parenchymasparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchymasparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach.

关键词： Laparoscopy Liver resection Hepatectomy Minimally-invasive Parenchyma-sparing Laparoscopicsurgery Hepatocellular carcinoma Liver metastasis Liver lesion Colorectal carcinoma

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