Liver and Biliary Tract Surgery Embryological Anatomy to 3D-Imaging and Transplant Innovations

640 Pages·2007·119.38 MB·English

by  Constantine C. Karaliotas

kroYweNneiWregnirpS
Constantine .hC Karaliotas
Christoph .E Broelsch
Nagy .A Habib ).sdE(
reviL and Biliary Tract Surgery
Embryological Anatomy
ot 3D-Imaging and Transplant Innovations
kroYweNneiWregnirpS
Constantine Ch. Karaliotas, MD, PhD
Chairman of 2nd Surgical Department and Surgical Oncology Unit
in Red Cross Hospital, Athens, Greece
Christoph .E Broelsch, ,DM SCAF
Professor and Chairman, Department of General Surgery and Transplantation,
University Clinic Essen, Germany
Nagy .A Habib, ChM, SCRF
Professor of Hepatobiliary Surgery, Imperial ,egelloC
Hammersmith Hospital, London, KU
This work si subject to copyright.
llA rights are reserved, whether the whole or part of the material is
concerned, specifically those of translation, reprinting, re-use of
illustrations, broadcasting, reproduction by photocopying machines or
similar means, and storage in data banks.
Product Liability: The publisher can give no guarantee for all the
information contained in this book. This does also refer to information
about drug dosage and application thereof. In every individual case the
respective user must check its accuracy by consulting other pharmaceutical
literature. The use of registered names, trademarks, etc. in this publication
does not imply, even in the absence of a specific statement, that such
names are exempt from the relevant protective laws and regulations and
therefore free for general use.
© 2006 Springer-Verlag/Wien
Printed in Greece
SpringerWienNewYork si part of Springer Science + Business Media
springer.com
Printing: .I Sideris Publishing, Athens, Greece
Printed on acid-free and chlorine-free bleached paper
:NIPS 81387711
With more than 430 figures, 250 in colour
Cip data applied for
ISBN-10 3-211-49275-5 SpringerWienNewYork
ISBN-13 978-3211-49275-8 SpringerWienNewYork
This Book si Dedicated to
Evangelos Papaevangelou
,DM PhD
Professor of Surgery- University of Athens
Former Chairman of Surgery in Red Cross Hospital, Athens - Greece
Former President of the
Hellenic Surgical Society
and 32 d Panhellenic Surgical Congress
nI" admiration for his scholarship in many fields,
for his zeal sa teacher, surgeon, and administrator"
"In the judicious discharge of these interdependent functions
he has unfailingly strengthened the natural alliance
between humanism and surgery"
We are like dwarfs seated on the shoulders of giants.
If we see more and further than they,
it is not due to our own clear eyes or tall bodies,
but because we are raised on high
and upborne by their gigantic bigness.
Bernard of Chartres
Chancellor in 1119
ECAFERP
The 25th Panhellenic Surgical Congress is offering the present textbook of surgery to all participants on one of
the hot surgical topics: hepatobiliary surgery: I" wonder what the young surgeon learn when they attend a national
surgical congress?" It is well known that delegates and young surgeons attend sessions on surgical topics of great
interest, such as round table discussions, lectures on specific issues by distinguished Greek and foreign guests,
postgraduate courses, follow live operations transmitted from operating rooms, meet experts describing their own
techniques, debate scientific problems and ideas with well known pioneers in the field, and go home to review
the scientific programme and their notes from the sessions attended.
Pioneers from both the international and Greek Hepatobiliary Club, present their combined experience,
describe techniques for hepatic and biliary surgery and explore future trends. It si important for all of us to know
what si really "innovative" in hepatobiliary surgery. New thinking is both an initiation and a "nouveaute" that
pushes at the frontiers in surgery. This book addresses all the main topics in Hepatobiliary surgery including living
related and conventional cadaveric transplantation, new trends in hepatic surgery, new applications for laparosco-
pic surgery, especially laparoscopic exploration of the biliary tree, the changing face of biliary reoperation and
iatrogenic biliary stenoses and strictures, etc.
The book also covers cutting-edge research and technological advances that will shape the surgery of to-
morrow. There is little doubt that technological advances in preoperative imaging, such as 3-D reconstruction,
preoperative preparation with portal vein embolisation and operative techniques using bloodless FR resection
methods, are already changing the nature of liver surgery.
It will be interesting to see how surgery will benefit from advances in stem cell research, gene therapy, geno-
mics, proteomics and miRNA. I hope that this book will inspire young surgeons to invent, to dream and believe in
their imagination.
sA a surgeon who has participated in the evolutionary steps of biliary and hepatic surgery over the last deca-
des, I want to express my enthusiasm for this book, and my deep appreciation to the Organising Committee and
especially the President of the Congress, my friend Constantine Karaliotas, and the hope that this book will be
appreciated by all members of the 2006 Congress.
Evangelos J. Papaevangelou
Professor of Surgery
Former President of Hellenic Surgical Society
ECAFERP
With the coming of 2007, we are celebrating seventy nine years since the institution of the Hellenic Surgical
Society.
These years have proven very productive for surgery in Greece, mainly because the founders of our Society,
as well as all the great scientists of the Executive Committees that followed, offered all their knowledge in an
effort to upgrading surgery in Greece, so that it is now considered as worthy as surgery worldwide.
Wishing to honour the 79th anniversary of our Society and at the same time holding the 25th Panhellenic
Congress of Surgery, the present Executive Committee decided, among other, to publish a book titled "Liver and
Biliary Tract Surgery".
The aforementioned book, written in English so as to be read by doctors beyond Greek frontiers, is the result
of a very successful team work of some of the most significant scientists of our days. The President of the congress
and elect President of the Hellenic Surgical Society, Dr .C Karaliotas, Chairman of the Surgery and Surgical Onco-
logy Department of Red Cross Hospital in Greece, Professor Chistoph Broelsch, Chairman of the Transplantation
Center of Essen University in Germany and Professor Nagy Habib Chairman of the Hepatobiliary Department of
the Hammersmith Hospital in United Kingdom, are the editors of the present book.
The catalogue of authors includes 68 scientists very well known for their work, knowledge and literature
contribution, worldwide, from Greece, Germany, United Kingdom, United States and France.
SpringerWienNewYork, the Publisher is one of the highest reputed publishing Houses, and an additional gua-
rantee of the book's high quality.
Being the representative of the Hellenic Surgical Society, I wish to thank the editors, Doctors Karaliotas,
Broelsch and Habib for their hard work, all the authors for their valuable contribution and Springer publishers
who gave us the opportunity for that great edition. We look forward to a future cooperation.
It is our wish, this very special work of so many remarkable authors to receive the welcome it deserves.
Theophilos Polymeropoulos
President of the Hellenic Surgical Society
DROWEROF
Since in 2006 the art and practice of HPB surgery can be learnt from a variety of sources, which circumstances
did determine and touched the genesis of this book? In spite of the internet and e-learning and the many scientific
and medical meetings, a textbook still has a place in today's world as it provides junior and senior surgeons with a
definite and fundamental source of information to enhance clinical skill and management strategy.
This textbook has three Editors-authors and four sections, each reflective of their own particular perspective.
As each author has chosen different co-authors and topics, the textbook has been enriched with different philoso-
phies and ways of thinking about clinical approaches from which the reader will benefit.
The first and second sections are dedicated to embryology, anatomy and physiology, current diagnostic
techniques in hepatobiliary surgery and management of benign and malignant diseases of the biliary tract. Is one
of the most classical but basic and difficult knowledge for the HPB surgeon. The topics are mainly written by
authors from university centers of Greece and Red Cross Hospital of Athens and Hannover. Invaluable is the offer
of the two famous writers, professors .A Dalley and K.L. Moore from USA and Canada who have written the
chapter .I
The third section, is written from the Hammersmith Hospital doctors. They contributed to chapters covering
three different areas.
The first area reflects the unique activities where HPB department excels. Chapters are dedicated to new
techniques developed at the Hammersmith Hospital, such as radiofrequency assisted liver resection. This concept
was born and developed at the Hammersmith. It is with great pride that on the first anniversary of the launch of
Hammersmith device that one in four of all liver resections in the USA is performed with this technique. The new
technique allows HPB surgeons to perform liver resection with excellent results. In the vast majority of cases liver
resection can be performed without blood transfusion, and without the need to admit patients to intensive care
unit or high dependency unit. The development of the laparoscopic FR resection device is even more significant
as it will finally give the liver surgeon the opportunity to undertake laparoscopic liver resection safely. It will also
significantly reduce the length of hospitalisation and overall cost, rendering liver resection more competitive than
percutaneous tumour ablation and other non-surgical approaches.
The second area describes techniques that were developed by other teams, but adopted recently in Hammer-
smith HPB service. This includes the use of 3D imaging in the pre-operative planning of surgery and the adjuvant
use of SIRTEX for locally delivered radiotherapy.
The third area gives an insight into some of the research undertaken in the department of surgery, such as stem
cell and gene therapy. Several clinical trials have been performed and results, so far, are promising. We believe
that academic research goes hand in hand with modern surgery. Research holds the key for improvements in HPB
surgical outcomes. The up-to-date modern HPB surgeon will have to rely more and more on stem cell biology,
gene therapy, molecular engineering, microarray technology, chemotherapy signatures, genomics, proteomics,
metabonomics, nanotechnology, tissue engineering, medical device engineering and above all his or her creative
surgical handicraft to optimise the management of HPB patients.
The fourth section is dedicated to Liver Transplantations and is written from doctors of Liver Transplantation
Unit of Essen University from Germany. In the past two decades liver transplantation has become the standard
treatment in patients with chronic liver failure. Currently, it also represents the most effective therapy in acute
liver failure and in carefully selected patients with hepatocellular carcinoma. Technical innovations as well as an
Xll ii Foreword
explosion of basic and clinical knowledge in organ transplantation contributed to the success of liver transplan-
tation. This includes a standardization of operative preservation techniques and in particular new developments in
the field of immunosuppression. As a consequence, short term survival has improved tremendously.
Concerning the factors which gained increasing interest are those determining long-term survival, in
particular, recurrence of primary disease. It is one of the major challenges for the future to develop successful
strategies for the prevention and therapy of recurrent disease to reduce the risk for recurrence and to increase
survival. With increasing success the indication for liver transplantation is more and more broadened, although
organ availability will become the limiting factor. To reduce organ shortage, an optimal use of available organs
and an extension of the donor pool is inevitable. Split liver transplantation and living-related liver transplantation
are the most effective innovations to increase organ availability and to relieve organ shortage.
This textbook comes at a critical time for liver surgery. During the last 3 decades there have been major
advances in liver surgery, such as complex liver surgery and liver transplantation. However, no major break-
through has happened in the last few years, even laparoscopic liver surgery did not gain its expected popularity
because of the technology gap. Unfortunately, liver surgery has been on the defensive. Instead of progressing, the
contrary has happened, and liver surgery is receding from the high ground. Facing the onslaught of major break-
throughs in interventional radiology and oncology conventional orthodox liver surgery indications, such as rese-
ction of small solitary tumour, were being questioned. Furthermore, major HPB meetings were uninspiring, rich
in style, but poor in substance. The major chiefs of liver surgery were repeating old positions with loud voices, but
with no convincing arguments.
In all our sections of this textbook we have concentrated on new developments, which Professor Papaevan-
gelos alluded to in his preface as ,"s6tuaevuon" in the hope of firing the imagination of HPB surgeons and of attra-
cting young talent to this speciality.
HPB surgery and medicine are in dynamic motion propelled by knowledge, discovery and innovation. Curren-
tly, the HPB surgeon has to face the challenge of how to integrate and to work closely with the oncologist, gastro-
enterologist, radiologist and pathologist in a multi-disciplinary approach. In the future the challenge will be even
greater. In this new era, the HPB surgeon will have to interact with new officers who will make discoveries lead
by science and technology. It is in this spirit that this textbook has been designed and prepared.
Finally, we would like to thank our co-authors and all contributors for giving us the privilege to contribute to
this textbook and to all our colleagues who assisted with the manuscripts. Lastly, we hope that readers of this book
will be inspired by the science, technical surgical handicraft, and spirit of this book which will equip them with
new skills to offer optimal management to their patients.
Constantine Karaliotas
Christoph Broelsch
Nagy Habib
Editors