《Progress of Liver Resection for Hepatocellular Carcinoma in Central Taiwan》培训课件.pptVIP

Disease-free Group 2 Group 1 P = 0.011 Overall Survival rate P = 0.009 Group 2 (n=270) Group 1 (n=51) 5y 32% 5y 56% 5y 52% 5y 82% Conclusion Unroofing hepatectomy may facilitate a peeling-off the deeply-located, pushing type of HCC whci is adjacent to the major intrahepatic vessels, this procedure may be justified for selected cirrhotic patients who do not suitable for a major hepatectomy. (Wu C-C et al: J Surg Oncol 2015;111:396-403) Right hepatectomy (or hemihepatectomy) involves resection of segments V-VIII Left hepatectomy involves resection of segments (II-IV) Right lobectomy (also known as extended right hepatectomy, or right trisegmentectomy) involves resection of all segments lateral to the umbilical fissure (IV-VIII, and sometimes I) Extended left hepatectomy (or left trisegmentectomy includes resection of all liver medial to the umbilical fissure and a portion of the right liver (segments II-IV and segments V and VIII) Left lobectomy (also known as left lateral segmentectomy) involves resection of all liver medial to the umbilical fissure only (segments II and III) * * * Fig 1. Representative macroscopic appearance of hepatocellular carcinoma in groups A, B, C, and D. Dotted lines denote the resection lines. A, B, C-1, C-2, and D-2 show the cases of marginal resection (MR). Simple nodular (SN) type withliver cirrhosis. (B) SN type without cirrhosis. (C-1 and C-2) Non-SN type with cirrhosis. (C-1) SN type with extranodular growth (SNEG). (C-2) Infiltrative (I) type. (D-1 and D-2) Non-SN type with-out cirrhosis. (D-1) Confluent multinodular(CM) type. (D-2) Eggel massive (M) type. * Resection of 1° (first diagnosed) HCC or recurrent HCC with right heart tumor thrombi under CPB (1998-2008) Age Sex HCC Tumor size Hx procedure EBL (ml) Cirrhosis Complication recurrence Lung meta Outcome 43 F Recur. 2cm S7 partial resection 7000 + Intraabd. hematoma 6 m lung meta Yes 14m die 52 M 1° 3cm S7 partial resection 120