Outcomes of central hepatectomy versus extended hepatectomy.

2019-06

Chan, Jenny

Bradshaw, Luke

Houli, Nezor

Weinberg, Laurence

Perini, Marcos V

Fink, Michael A

Muralidharan, Vijayaragavan

Starkey, Graham M

Jones, Robert M

Wang, Bao Zhong

Christophi, Christopher

Nikfarjam, Mehrdad

Central bisectionectomy

Central bisegmentectomy

Central hepatectomy

Extended hepatectomy

Mesohepatectomy

Journal Article

0000-0001-7403-7680

0000-0002-0165-1564

0000-0001-8247-8937

0000-0003-4866-276X

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10.1016/j.hbpd.2019.03.005

Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290-840) vs. 523 min (310-860), P = 0.328)], intraoperative blood loss [850 mL (400-1500) vs. 650 mL (100-2000), P = 0.746) or patients requiring intraoperative blood transfusion [(1 (9.1%) vs. 7 (30.4%), P = 0.227)]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5-23) vs. 12 days (4-85), P = 0.244]. CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.

link

Hepatobiliary & Pancreatic Diseases International : HBPD INT 2019; 18(3): 249-254

Hepatobiliary & Pancreatic Diseases International : HBPD INT

1499-3872