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Benefit of Systematic Segmentectomy of the Hepatocellular Carcinoma Revisiting the Dye Injection Method for Various Portal Vein Branches

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Author(s)
안근수강구정김용훈임태진권중혁
Alternative Author(s)
Ahn, Keun SooKang, Koo JeongKim, Yong HoonLim, Tae JinKwon, Jung Hyeok
Publication Year
2013
Abstract
Background: Systematic segmentectomy is useful in treating small hepatocellular
carcinoma in the cirrhotic liver. However, accomplishment of an exact
systematic segmentectomy still remains a challenging procedure because of
the variable anatomy of portal branches. We evaluated the usefulness of the
dye injection method for systematic segmentectomy, which focuses on the
various patterns of portal vein (PV) branches feeding the tumor.
Methods: From January 2001 to May 2011, systematic segmentectomy by the
dye injectionmethodwas performed in 70 patients.We evaluated the efficiency
of systematic segmentectomy by ultrasonogram-guided dye injection into the
portal branches that feed the tumor-bearing segments. The type of tumorfeeding
PV branch, perioperative outcome, and survival rates were analyzed
retrospectively.
Results: There were variations in the PV branches that fed the masses in 70
patients in whom the dye injectionmethod for anatomical segmentectomy was
tried. Forty masses (54.8%) were fed by a single main PV branch (type 1),
17 masses (23.3%) by a couple of PV branches (type 2), and 11 masses
(15.1%) were supplied partially by single PV branch (type 3). In 5 patients
(7.1%), masses were supplied by several small distributed PVs (type 4). For
types 1 and 2, the tumor-bearing segments were resected anatomically with
the help of staining; type 3 was partially stained and as the opposite side was
not discrete, it was demarcated through counterstaining; and in type 4, dye
injection could not be performed. Anatomical systematic segmentectomy was
obtained in types 1 to 3; however, nonanatomical resection was inevitable
for type 4. The 3- and 5-year overall survival rates were 80.5% and 67.2%,
respectively, and the 3- and 5-year disease-free survival rates were 61.5%
and 42.5%, respectively. The anatomical segmentectomy group showed better
overall and disease-free survival than the nonanatomical group, even though
it is not significant statistically.
Conclusion: Systematic segmentectomy by the dye injection method overcomes
the variation in PV tributaries in the segments and can be done according
to the natural branching pattern of PVs.
Keywords: anatomical, carcinoma, hepatocellular, segmentectomy, systematic
Department
Dept. of Surgery (외과학)
Dept. of Radiology (영상의학)
Publisher
School of Medicine
Citation
Annals of Surgery, Vol.258(6) : 1014-1021, 2013
Type
Article
ISSN
0003-4932
DOI
10.1097/SLA.0b013e318281eda3
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/35039
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