Associated liver and multivisceral resections: should we extend the frontiers of resectability?

Combined liver and multivisceral resections (CLMVRs) are rare procedures that demand extensive surgical skills. Few reports have discussed the benefit of these complex procedures and their indications are poorly defined. The aim of the present study is to present short- and long-term results of CLMVRs in primary and metastatic malignancies, including a risk analysis for perioperative morbidity and mortality. A review of our prospective surgical database between November 2007 and August 2013 identified 21 patients who had undergone CLMVRs. Preoperative radiologic evaluation and laboratory data, intraoperative results, hospital outcomes, and long-term follow-up were analyzed. CLMVRs were performed due to metastatic disease from different sites in 17 patients, and due to direct local invasion of the liver in the remaining 4 cases. Major hepatectomy was performed in 7 cases. Morbidity was 57% and 90-day postoperative mortality was 9%. Gender and resection of more than 4 organs were found as statistically significant risk factors to develop major complications. Five of 7 patients with 4 or more organs resected presented major complications including mortality (p = 0.026). The overall 1- and 3-year survival rates were 57 and 24%, respectively. Patients undergoing CLMVRs experience acceptable postoperative morbidity and mortality rates. Surgery should be performed only in carefully selected patients, considering their preoperative comorbidities, and in high-volume centers.