Challenges in Hepatobiliary Surgery and Liver Transplant

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 2879

Special Issue Editors

Department of Transplantation Surgery, Aristotle University of Thessaloniki, Hippokration Hospital, 541 24 Thessaloniki, Greece
Interests: surgery; general surgery; renal transplantation; liver transplantation; colorectal surgery; organ transplantation; pancreas transplantation
Special Issues, Collections and Topics in MDPI journals
American University of Beirut, Beirut, Lebanon
Interests: hepatocellular carcinoma; orthotopic liver transplantation; liver resection; biliary cancer; surgical education
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Interests: hepatobiliary surgery; liver cancer; liver transplantation; pancreas transplantation; living donor liver transplantation; cholangiocarcinoma

Special Issue Information

Dear Colleagues,

The goal of this Special Issue is to present a review of the different categories of liver disease, as well as address the role of surgery in managing these complex diseases. The issue will include chapters written by international experts having to do with the most current indications and guidelines regarding the diagnoses and management of liver diseases, as well as a variety of technical elements involved in surgical procedures. Different surgical techniques involved in performing a hepatectomy will be discussed, including various instruments used, as well as the effect of modern technology as evidenced by novel procedures. Specifically, the role of minimally invasive hepatectomy (laparoscopic, hand-assisted, robotic) and how it compares to the open procedure, as well as more novel procedures, such as the ALPPS (associating liver partition and portal vein ligation) procedure. An important focus of the book will be to identify the proper place for all these hepatectomy methods in the armamentarium of the experienced hepatobiliary surgeon, including the role of locoregional treatments such as ablation and embolization as adjuncts. Finally, the role of hepatectomy compared to orthotopic liver transplantation will be presented, so that the reader can have a well-rounded picture of the challenges and opportunities involved.

Dr. Georgios Tsoulfas
Prof. Dr. Nahel Elias
Prof. Dr. Walid Faraj
Guest Editor

Manuscript Submission Information

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Keywords

  • Liver resection
  • Liver transplantation
  • Hepatocellular cancer
  • Cholangiocarcinoma
  • Living donor liver transplantation
  • Hepatobiliary Surgery
  • Hepatoblastoma
  • Laparoscopic Liver surgery
  • Minimally invasive liver surgery
  • Colorectal liver metastatic disease

Published Papers (1 paper)

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Review

9 pages, 10014 KiB  
Review
Is the Rationale of Anatomical Liver Resection for Hepatocellular Carcinoma Universally Adoptable? A Hypothesis-Driven Review
by Young-Jen Lin and Cheng-Maw Ho
Medicina 2021, 57(2), 131; https://doi.org/10.3390/medicina57020131 - 02 Feb 2021
Cited by 4 | Viewed by 2480
Abstract
Surgical resection is the first-line curative treatment modality for resectable hepatocellular carcinoma (HCC). Anatomical resection (AR), described as systematic removal of a liver segment confined by tumor-bearing portal tributaries, may improve survival by reducing the risk of tumor recurrence compared with non-AR. In [...] Read more.
Surgical resection is the first-line curative treatment modality for resectable hepatocellular carcinoma (HCC). Anatomical resection (AR), described as systematic removal of a liver segment confined by tumor-bearing portal tributaries, may improve survival by reducing the risk of tumor recurrence compared with non-AR. In this article, we propose the rationale for AR and its universal adoption by providing supporting evidence from the advanced understanding of a tumor microenvironment and accumulating clinical experiences of locoregional tumor ablation therapeutics. AR may be advantageous because it completely removes the en-bloc by interrupting tumor vascular supply and thus extirpates the spreading of tumor microthrombi, if they ever exist, within the supplying portal vein. However, HCC is a hypervascular tumor that can promote neoangiogenesis in the local tumor microenvironment, which in itself can break through the anatomical boundary within the liver and even retrieve nourishment from extrahepatic vessels, such as inferior phrenic or omental arteries. Additionally, increasing clinical evidence for locoregional tumor ablation therapies, such as radiofrequency ablation, predominantly performed as a non-anatomical approach, suggests comparable outcomes for surgical resection, particularly in small HCC and colorectal, hepatic metastases. Moreover, liver transplantation for HCC, which can be considered as AR of the whole liver followed by implantation of a new graft, is not universally free from post-transplant tumor recurrence. Overall, AR should not be considered the gold standard among all surgical resection methods. Surgical resection is fundamentally reliant on choosing the optimal margin width to achieve en-bloc tumor niche removal while balancing between oncological radicality and the preservation of postoperative liver function. The importance of this is to liberate surgical resilience in hepatocellular carcinoma. The overall success of HCC treatment is determined by the clearance of the theoretical niche. Developing biomolecular-guided navigation device/technologies may provide surgical guidance toward the total removal of microscopic tumor niche to achieve superior oncological outcomes. Full article
(This article belongs to the Special Issue Challenges in Hepatobiliary Surgery and Liver Transplant)
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