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The Liver Tunnel

Intention-to-treat Validation of a New Type of Hepatectomy

Torzilli, Guido, MD, PhD, FACS; Procopio, Fabio, MD; Viganò, Luca, MD, PhD; Costa, Guido, MD; Fontana, Andrea, MD; Cimino, Matteo, MD; Donadon, Matteo, MD, PhD; Del Fabbro, Daniele, MD

doi: 10.1097/SLA.0000000000002509

Objective: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion.

Background: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique.

Methods: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating veins if MHV resection is necessary.

Results: Twenty consecutive patients met the inclusion criteria: 17 had colorectal liver metastases, 1 had hepatocellular carcinoma, 1 had mass-forming cholangiocarcinoma, and 1 had mixed hepatocellular carcinoma—mass-forming cholangiocarcinoma. Nineteen patients underwent LT. The MHV was resected in 6 patients, always sparing segments 4i and 5. Overall, 180 lesions were removed (median 7; range 1–37): 79 lesions were included in the LT specimen (median 3; range 1–13). There was no in-hospital 90-day mortality. Overall morbidity occurred in 10 (50%) patients: major in 2 (10%). All complications were managed conservatively. After a median 15-month follow-up (range 6–48), 2 instances of cut-edge local recurrences were observed.

Conclusions: This study shows that LT is technically feasible and safe. Further studies are needed for standardizing its use.

Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy.

Reprints: Guido Torzilli, MD, PhD, FACS, Professor of Surgery, Director Department of Surgery & Division of Hepatobiliary & General Surgery, Humanitas University, Humanitas Research Hospital-IRCCS, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy. E-mail:

The authors declare no conflict of interests.

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