Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Viene ideato il “tunnel nel fegato”

Il chirurgo milanese Guido Torzilli, all’Humanitas University di Rozzano (Milano) propone che i tumori che coinvolgono S1, S4 e / o S8 e infiltrano o entrano in contatto con la vena sovraepatica mediana alla confluenza nella vena cava inferiore, possono essere rimossi in modo conservativo  con l’approccio del “tunnel del fegato”.

Il “tunnel” introduce un ulteriore fattore a favore della politica di risparmio del parenchima epatico per lesioni localizzate centralmente nel fegato e che infiltrino una sovraepatica centrale nel fegato.

La referenza bibliografica per questo evento è:

Guido Torzilli, Matteo Cimino, Fabio Procopio, Guido Costa, Matteo Donadon, Daniele Del Fabbro, Andrea Gatti, Carlos A. Garcia-Etienne: Conservative Hepatectomy for Tumors Involving the Middle Hepatic Vein and Segment 1: The Liver Tunnel. In: Annals of Surgical Oncology, vol. 21, no. 8, pp. 2699, 2014, ISSN: 10689265, (Cited by: 18; All Open Access, Bronze Open Access).

Abstract

Background: For lesions invading the middle hepatic vein (MHV) at caval confluence (CC) the mini-mesohepatectomy(MMH) was proposed.1 If the lesion is extended to the paracaval portion of segment 1(S1) in contact or invading the MHV a new procedure is proposed. Methods: Case-1: mass forming cholangiocarcinoma (MFCCC) 4cm in size invading the MHV and in contact with right (RHV) and left hepatic vein (LHV) at the CC. In Case-2, two colorectal liver metastases (CLM) both 2cm in size occupied S1 (T1) and S8 (T2): T1 was located between RHV and the inferior vena cava (IVC), T2 was in contact with MHV at CC. According to tumor-vessel intraoperative-ultrasound classification2 and color-flow analysis3 parenchyma-sparing procedure was performed. Results: In Case-1 a communicating vein (CV) between RHV and MHV was detected at color-flow-IOUS. Contacts between MFCCC with RHV and LHV were confirmed at IOUS as detachable. In Case-2 contact between T1 with MHV was confirmed at IOUS as detachable. Liver-tunnel with IVC and main portal vein bifurcation exposure was performed resecting the MHV in Case-1 and preserving it in Case-2. Both patients had ad an uneventful postoperative course and were discharged on the 8th postoperative day. Conclusion: For tumors involving S1, S4s and/or S8 and infiltrating or in contact with the MHV at the CC, can be removed in a conservative manner by means of the herein described ‘‘Liver Tunnel’’ approach. The latter introduces a further step in favour of parenchyma-sparing policy for centrally located lesions with complex tumor-vessel relationship. © 2014, Society of Surgical Oncology.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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