Advances in image guided conventional and minimal invasive liver surgery
Department of General, Visceral and Transplantation Surgery, Charité Campus Virchw Clinic, University Medicine, Berlin, Germany. Minerva chirurgica
(Impact Factor: 0.68).
Technological developments, advances in perioperative medicine and ongoing scientific research have led to reduced rates of mortality and morbidity in patients undergoing major liver surgery. Under these conditions, the frontier of resectability is constantly in movement towards more complex cases with extended tumor spread and potentially minimized remnant liver volume. A promising technique to support oncological correct and safe liver surgery is the introduction of preoperative computer based planning models and intraoperative navigation systems. Whereas three-dimensional (3D) liver models are commercially available and have been clinically implemented, the use of navigation systems is currently under evaluation by different groups using a variety of techniques. This manuscript is meant to give the reader an overview on current developments, difficulties and future aspects of image guided liver surgery.
Available from: Ikuo Konishi
- "The largest LN in an involved region may not always be the involved LN. To compare the preoperative image with the pathological diagnosis in node-by-node manner, data accumulated from imageguided surgery, currently used for gastric or liver cancer   are necessary. Although the detection rate of at least one LN in a region was increased when involved LNs existed, the detection rate was still 75%, not 100% (Fig. 1b). "
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ABSTRACT: The sensitivity of the current 10mm cut-off diameter that is used to diagnose lymph node (LN) metastasis is too low. This is the first study to develop a new criterion to diagnose LN metastasis in a region-by-region manner using multi-detector computed tomography (MDCT).
1) The short-axis diameter of the LNs in MDCT images from 1-mm slices obtained immediately prior to surgery was compared with the pathological diagnosis in 78 uterine cervical cancer patients undergoing primary surgery. For the region-by-region analysis, we divided para-aortic and pelvic spaces into 13 regions. 2) In 28 cases in which patients received neoadjuvant chemotherapy (NAC) followed by surgery, we compared MDCT images before and after NAC.
1) The optimal cut-off in the region-by-region analysis was 5mm, yielding 71% sensitivity and 79% specificity. 2) NAC significantly decreased LN size (p<0.0001). NAC decreased the number of swollen LN regions (>5mm) from 51% (81/158) to 26% (41/158).
The new criterion developed using MDCT could be effective for accurately assessing LN status. It also facilitates the assessment of NAC efficacy regarding the eradication of LN metastases.
Gynecologic Oncology 10/2013; 131(3). DOI:10.1016/j.ygyno.2013.10.014 · 3.77 Impact Factor
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ABSTRACT: Partial liver resection is a well established treatment for patients with liver tumors. It is associated with significant morbidity and some mortality, even in high volume centers. Less invasive modalities are currently available and deserve a place in the armamentarium of liver surgeons. This review discusses the role of thermoablation as a treatment modality for liver tumors. The minimal invasive possibility of percutaneous ablation is a great advantage. The limitation of ablation is the high incidence of ablation site recurrences. The inflammatory response is associated with the initiation of cancer at sites of chronic inflammation. There is also accumulating evidence that progression of tumors is also enhanced by an ongoing inflammatory response. The common denominator probably is angiogenesis. The paper supplies data about the interrelationship between inflammation, angiogenesis and tumor growth. Ablation of liver tumors is associated with a low inflammatory response, especially if it is performed percutaneous and thus deserves to be considered in patients with liver tumors.
Minerva chirurgica 12/2011; 66(6):561-72. · 0.68 Impact Factor
Available from: Nicolas C Buchs
Surgical Endoscopy 07/2012; 27(2). DOI:10.1007/s00464-012-2481-3 · 3.26 Impact Factor
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