Open AccessMinor-but-Complex Liver Resection
Author(s) -
Lucio Urbani,
Gianluca Masi,
Marco Puccini,
P. Colombatto,
Caterina Vivaldi,
Riccardo Balestri,
Antonio Marioni,
Valerio Prosperi,
Francesco Forfori,
G Licitra,
Chiara Leoni,
A Paolicchi,
Piero Boraschi,
Alessandro Lunardi,
Carlo Tascini,
Maura Castagna,
P Buccianti
Publication year - 2015
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000001188
Subject(s) - medicine , hepatectomy , retrospective cohort study , resection , mortality rate , surgery , cohort , gastroenterology
Major hepatectomy (MH) is often considered the only possible approach for colorectal liver metastasis (CRLM) at the hepato-caval confluence (CC), but it is associated with high morbidity and mortality. With the aim to reduce MH, we developed the “minor- but -complex” (M b C) technique, which consists in the resection of less than 3 adjacent liver segments with exposure of the CC and preservation of hepatic outflow until spontaneous maturation of peripheral intrahepatic shunts between main hepatic veins. We have evaluated applicability and outcome of M b C resections for the treatment of CRLM involving the CC. In this retrospective cohort study, all consecutive liver resections (LR) performed for CRLM located in segments 1, 7, 8, or 4a were classified as MINOR – removal of <3 adjacent segments; M b C – removal of <3 adjacent segments with CC exposure; and MH – removal of ≥3 adjacent segments. The rate of avoided MH was obtained by the difference between the rate of potentially MH (PMH) plus potentially inoperable cases and the rate of the MH performed. Taking into account that postoperative mortality is mainly related to the amount of resected liver, M b C was compared with minor resections for safety, complexity, and outcome. Of the 59 LR analyzed, 29 (49.1%) were deemed PMH and 4 (6.8%) potentially inoperable. Eventually, MH was performed only in 8 (13.5%) with a decrease rate of 42.4%. Minor LR was performed in 23 (39.0%) and M b C LR in 28 (47.5%) patients. Among M b C cases, 32.1% had previous liver treatments, 39.3% required vascular reconstruction (no reconstructed vessel thrombosis occurred before maturation of peripheral intrahepatic shunts between main hepatic veins), and 7.1% had grade IIIb–IV complications, their median hospital stay was 9 days and 90-day mortality was 0%. After a median follow-up of 22.2 months, oncological results were comparable with those of minor resections. M b C hepatectomy lowers the need for MH and allows for the resection of potentially inoperable patients without negative impact on safety and survival.