C Codony1, S López-Ben2,3, M Albiol2,3, L Falgueras2,3, E Castro2,3, A Codina-Barreras2, M Casellas2, J Gil2, A Codina-Cazador2,3, J Figueras2,4. 1. Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain. clcodony@gmail.com. 2. Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain. 3. Facultat de Medicina, Universitat de Girona, Girona, Spain. 4. Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
Abstract
OBJECTIVE: Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery. MATERIALS AND METHODS: We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008-March 2015). Data were collected prospectively and analyzed with SPSS 21.0. RESULTS: 12 patients were included. 50 % were male and 50 % were female with a mean age of 59 ± 10 years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75 % of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58 % preoperative portal embolization was performed. Major hepatectomies were performed (66.7 % extended right hepatectomy, 33.3 % left extended hepatectomy). The 83.3 % of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50 % of the patients according to Dindo-Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90 days was 33 % due to hepatic failure and biliary fistula. In December 2015, 33 % of the patients are still alive with a mean survival of 19 months (13-23) with an ECOG Performance Status of 0. CONCLUSION: Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.
OBJECTIVE: Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery. MATERIALS AND METHODS: We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008-March 2015). Data were collected prospectively and analyzed with SPSS 21.0. RESULTS: 12 patients were included. 50 % were male and 50 % were female with a mean age of 59 ± 10 years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75 % of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58 % preoperative portal embolization was performed. Major hepatectomies were performed (66.7 % extended right hepatectomy, 33.3 % left extended hepatectomy). The 83.3 % of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50 % of the patients according to Dindo-Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90 days was 33 % due to hepatic failure and biliary fistula. In December 2015, 33 % of the patients are still alive with a mean survival of 19 months (13-23) with an ECOG Performance Status of 0. CONCLUSION: Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.
Authors: Graeme J Poston; René Adam; Steven Alberts; Steven Curley; Juan Figueras; Daniel Haller; Francis Kunstlinger; Gilles Mentha; Bernard Nordlinger; Yehuda Patt; John Primrose; Mark Roh; Philippe Rougier; Theo Ruers; Hans Joachim Schmoll; Carlos Valls; Nick Jean-Nicolas Vauthey; Marleen Cornelis; James P Kahan Journal: J Clin Oncol Date: 2005-10-01 Impact factor: 44.544
Authors: J G Fortner; M H Shiu; D W Kinne; D K Kim; E B Castro; R C Watson; W S Howland; E J Beattie Journal: Ann Surg Date: 1974-10 Impact factor: 12.969
Authors: Ivan Capobianco; Karl J Oldhafer; Mohammed-Hossein Fard-Aghaie; Ricardo Robles-Campos; Roberto Brusadin; Henrik Petrowsky; Michael Linecker; Arianeb Mehrabi; Katrin Hoffmann; Jun Li; Asmus Heumann; Roberto Hernandez-Alejandro; Mauro Enrique Tun-Abraham; Elio Jovine; Matteo Serenari; Bergthor Bjornsson; Per Sandström; Ruslan Alikhanov; Mikhail Efanov; Paolo Muiesan; Andrea Schlegel; Thomas M van Gulik; Pim B Olthof; Gregor Alexander Stavrou; Lina Maria Serna-Higuita; Alfred Königsrainer; Silvio Nadalin Journal: Hepatobiliary Surg Nutr Date: 2022-02 Impact factor: 7.293