タイムテーブル 第 1 日目 5 月30日（水） - æ ªå¼ä¼šç¤¾ã‚³ãƒ³ã‚°ãƒ¬

KL1 Liver Resection for Tumors
University Denis Diderot
○Jacques…Belghiti
Analysis…of…large…experience…of…liver…resection…for…tumors…showed…two…important…informations:…(a)…the…
rate…of…resection…for…benign…liver…tumors…is…decreasing…and…(b)…both…primary…and…metastatic…tumors…are…
often…associated…with…underlying…diseased…liver…parenchyma.…The…goal…of…liver…resection…for…malignant…
tumor…is…to…reduce…the…patient’s…risk…with…maximum…tolerance…of…resection…procedure.…It…is…difficult…to…
achieve…a…low…risk…procedure…in…more…and…more…aged…patients…with…significant…severe…co-morbidities.…
Resection…of…malignant…tumors…should…follow…some…oncologic…rules…which…include…wide…excision…of…the…
tumor…and…a…regional…lymphadenectomy.…There…are…evidences…that…an…anatomic…resection…in…HCC…and…
hilar… cholangiocarcinoma… improves… survival.… For… non-anatomic… resections… the… optimal… width… of… the…
resection…margin…varies…with…the…pathological…type…of…tumor.…Anterior…approach…to…major…hepatectomy…is…
a…“no-touch”…technique…that…minimizes…manipulation…of…the…tumor-bearing…liver.…Recommendations…for…the…
extent… of… hepatectomy… vary… with… the… pathological… type… of… the… tumor… identified… by… its… radiologic…
characteristics…and…occasionally…by…percutaneous…liver…biopsy.…The…extent…of…hepatectomy…is…modified…by…
the… functional… reserve… of… the… liver… remnant.… Postoperative… morbidity… is… an… independent… predictor… of…
survival.…Postoperative…hepatic…dysfunction…can…be…minimized…by…preoperative…liver…volume…modulation…
with…portal…vein…embolization,…avoidance…of…parenchymal…ischemia,…preservation…of…venous…drainage…of…the…
liver…remnant,…and…minimizing…blood…loss.…Laparoscopic…liver…resection…which…is…increasingly…performed…
for…malignant…tumors…should…incorporate…the…principles…of…oncologic…resection.
Keynote
Lecture
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