ABSTRACTS 2ND INTERNATIONAL LIVER SYMPOSIUM–2014

LiverTra

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Introduction: Laparoscopic liver resection has evolvedand widened in its scope. We review our initial experiencein laparoscopic liver resection to assess the early outcomesand feasibility of the procedure.Methods: Retrospective analysis of prospectively collecteddata of all laparoscopic liver resections for various indica-tions at our institute between January 2011 and July2013. Liver and biliary pathologies, primary gall bladdercancer (GBC) in selected fit patients, who after evaluationand/ or staging underwent laparoscopic liver resection,were included. Duration, intraoperative blood loss andpostoperative outcomes were recorded.Results:Of the 64 patients inwhom laparoscopic liver resec-tion was attempted, majority were for GBC (26) followed byhepatic hydatidosis (16), hepatocellular carcinoma (HCC)(10), besides others. Five patients with hydatid cyst were con-verted due to technical difficulty and one patient with GBCwas converted for anesthesia considerations. Median dura-tion of surgery in minutes for GBC, hepatic hydatidosisand liver tumour was 330 (240–1000), 240 (180–300) and195 (150–270) respectively. The corresponding median(range) blood loss in mL was 150 (100–300), 110 (50–250)and 200 (100–300) respectively. The median hospital staywas 5 (3–8) days. Median lymph node yield in GBC patientswas 10 (4–31). Liver resection margins were free in all pa-tients. No postoperative mortality was encountered.Morbidity in GBC included Grade A (ISGLS) bile leak (1),intra-abdominal collection (1) and minor chyle leak (1).No patient suffered postoperative liver failure. One patientwith Hepatitis B related chronic liver disease, who under-went a non-anatomical resection of segment 6 HCC devel-oped ascites, which was diuretic-responsive. At a medianfollowupof 12(1-21)months, one patient ofGBCdevelopedlymph nodal recurrence. During a median follow up of16(1-23) months, one patient with HCC had a locoregionalrecurrence 9 months post-surgery, treated with transarterialchemoembolization.Conclusion: Laparoscopy liver resection is safe andfeasible in selected patients.

COMPARISON OF OUTCOMES IN IDEALDONOR AND EXTENDED CRITERIA DONORGRAFTS IN DECEASED DONORLIVER TRANSPLANT

Dronacharya Routh

Department of Gastrointestinal Surgery and LiverTransplantation, Army Hospital (R&R), Delhi Cantt, NewDelhi, India

Introduction: The number of patients who could benefitfrom liver transplantation markedly exceeds the number

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of available donors. This increasing gap has fuelled effortsto maximize existing donor pool and identify new avenues.Aims and objective: Compare the outcome in deceaseddonor liver transplant (DDLT) based on donor character-istics.Materials and methods: Donor and recipients' data wereanalyzed following DDLT fromMar 2007 to Feb 2013. Do-nors were grouped into either ideal donor (ID) or extendedcriteria donor (ECD) based on donor and graft relatedcharacteristics. Primary non-function (PNF) and patientsurvival were the primary endpoints while early graftdysfunction (EGD) and incidence of major postoperativecomplications were the secondary endpoints of the study.Results: There were 35 ECD and 11 ID grafts. On the basisof number of risk factors, patients were divided into 3 sub-groups: the ID group (n=11) received an ideal graft, theECD1 group (n = 23) received graft with 1/2 risk factorsand the ECD2 group (n = 12) received graft with 3/4 riskfactors. Patient survival at 3, 6 and 12 months were notdifferent (P > 0.05) whereas PNF occurred in three (6.5 %)patients and was not significantly different (P < 0.06), how-ever, it was influenced by cumulative number of risk factorsin the subgroup analysis. Both EGD (27.2% vs 25.7%) andmajor post-operative complications (18.2% vs 28.6%) werenot statistically significant in the two groups. A univariateanalysis of the donor risk factors detected hemodynamicfactors predictive for both PNF and mortality (P < 0.026,P < 0.018) and deranged LFT for PNF (P < 0.038) only.In the multivariate analysis adjusted for recipient age; he-modynamic risk factors andModel for End-stage Liver Dis-ease (MELD) score in the recipient were the only variablesindependently associated with PNF (P < 0.002, P < 0.016)and death (P < 0.001, P < 0.026).Conclusion:With the increasing shortage in the availabil-ity of deceased donors in a country like India, an extendedcriterion for selection of deceased donors will definitelyexpand the donor pool without adversely affecting theoutcome of liver transplantation.

PORTAL VEIN TUMOR THROMBUS: ROLE OFEXTERNAL BEAM RADIOTHERAPY

A. Abhishek, T. Kataria, K. Sharma, K. P. Karrthick,S. Vikraman, L. Kaur

Division of Radiation Oncology, Medanta Cancer Institute,Medanta – The Medicity, Gurgaon, Haryana, India

Background: Surgery has been the gold standard treat-ment for hepatocellular carcinoma (HCC), although,only 20% of the cases are actually found to be operable. Por-tal vein tumor thrombosis (PVTT), a known entity withHCC, is vital in deciding the prognosis and further

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