Artikel
A Single Center Experience in Extended Hepatectomy Is the right posterior sector of the liver more important than the left lateral one?
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Autoren
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Hamidreza Fonouni
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Arianeb Mehrabi
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Nassim Fard
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Reza Hafezi
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Mohammad Golriz
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Nuh Nabi Rahbari
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Koosha GhaziMoghaddam
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Markus Mieth
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Michael Kremer
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Peter Schemmer
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
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Markus W. Buechler
- Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
| Veröffentlicht: | 26. April 2013 |
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Gliederung
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Introduction: Extended hepatectomy (EH) is the only curative procedure in patients with large or multi nodular liver tumors, particularly centrally located ones. We present the result of our non-selected EH experiences during the last decade in term of right or left extended hepatectomy (rEH or lEH). In addition, we compared our analysis with a review of the literature.
Material and methods: The data of 171 performed EHs were obtained from our center database and divided into pre-, intra- and post-operative data. The data were analyzed and compared between rEH and lEH groups. Furthermore, we searched and gathered all original articles in the Medline database with more than 20 cases that underwent EH.
Results: from 171 EH 122rEH and 49lEH were evaluated. Colorectal metastases and cholangiocellular carcinoma were the most common indications of surgery. Portal vein embolisation was performed in 6.6% of the cases, all in rEH group. The mean operative time was 310min and pringle manoeuvre was applied in 17% of the cases with mean duration of 15min. Mean blood loss was 1560ml. Intraoperative pRBC and FFP transfusions were recorded in 42% and 29% of our entire patients, respectively. The amount of postoperative substituted RBC and FFP as well as the mortality rate were significantly higher in rEH group. 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; whereas, all of deaths occurred after rEH with an average rate of 13%.
Conclusion: lEH can be safely performed due to significant lower morbidity and mortality rate, specially for the central-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 higher value of preserving the right posterior sector.
