Article
A Single Center Experience of Extended Hepatectomy
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Authors
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Nassim Fard
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Arianeb Mehrabi
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Mohammadreza Hafezi
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Zakaria Khalil
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Hamidreza Fonouni
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Mohammad Golriz
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Nuh N. Rahbari
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Koosha Ghazi Moghadam
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Markus Mieth
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Michael Kremer
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Beat Müller
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Peter Schemmer
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Markus W. Büchler
- University of Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
| Published: | March 21, 2014 |
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Outline
Text
Introduction: Extended hepatectomy (EH), as an advanced technique in liver resection, is the only curative procedure in patients with large or multi nodular, particularly centrally located liver tumors. In this study, we present the analytic results of our non-selected EH experience during the last decade in term of extended right or left hepatectomy (rEH or lEH). In addition, we compared our analysis with the available literature.
Material and methods: The data of 171 performed EHs at our center were obtained from the center database and divided into pre-, intra- and post-operative parts. The data was analyzed and compared between rEH and lEH groups. In our review of the literature, we searched the Medline database and all original articles with more than 20 cases which contained data about EH were selected and analyzed.
Results: Data of 171 EH including 122 rEH and 49 lEH were evaluated in our case-series. Colorectal metastases followed by cholangiocellular carcinoma were the most common indications of surgeries. Portal vein embolization was performed in 6.6% of the cases, all in rEH group. The mean operative time was 310 minutes and Pringle maneuver was applied in 17% of the cases with mean duration of 15 min. The average amount of blood loss during our EH was 1560 ml. Moreover, intraoperative RBC and FFP transfusions were recorded in 42% and 29% of our entire patients, respectively. Except from blood loss all the other evaluated variables were observed with higher rate in our rEH rather than lEH which is also supported by the result of the review of literature. The amount of postoperative substituted RBC and FFP as well as the mortality rate were significantly higher in rEH group compare to lEH group. The average overall morbidity and mortality rates were 56% and 9%, respectively. Despite occurring postoperative complications in about one-third of cases in lEH group, there was no in-hospital mortality in this group; whereas, all of our deaths occurred after rEH with an average rate of 13%. All these findings were within the range of analyzed review of the literature.
Conclusion: lEH can be safely performed specially for the centrally-located liver tumors, when the surgeon has the choice to decide the side of the EH; however, rEH is technically easier. Better surgical outcomes associated with lEH, showing the high value of preserving the right posterior sector. In other word, it seems that the right posterior sector is more important than the left lateral one.
