Outcomes of central hepatectomy versus extended hepatectomy.
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
/ prevention & control
Blood Transfusion
Colorectal Neoplasms
/ pathology
Databases, Factual
Female
Hepatectomy
/ adverse effects
Humans
Length of Stay
Liver Neoplasms
/ secondary
Male
Middle Aged
Operative Time
Postoperative Complications
/ etiology
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Victoria
Young Adult
Central bisectionectomy
Central bisegmentectomy
Central hepatectomy
Extended hepatectomy
Mesohepatectomy
Journal
Hepatobiliary & pancreatic diseases international : HBPD INT
ISSN: 1499-3872
Titre abrégé: Hepatobiliary Pancreat Dis Int
Pays: Singapore
ID NLM: 101151457
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
23
09
2018
accepted:
12
03
2019
pubmed:
17
4
2019
medline:
22
1
2020
entrez:
17
4
2019
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
METHODS
METHODS
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.
RESULTS
RESULTS
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].
CONCLUSIONS
CONCLUSIONS
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.
Identifiants
pubmed: 30987899
pii: S1499-3872(19)30041-4
doi: 10.1016/j.hbpd.2019.03.005
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
249-254Informations de copyright
Copyright © 2019. Published by Elsevier B.V.