J C Emond1, R Polastri. 1. Department of Surgery, University of California, San Francisco, USA.
Abstract
BACKGROUND: Anatomical resection has become the basis for the treatment of hepatic tumors recognizing the portal-based intrahepatic architecture of the liver. In transplantation, these principles have been applied to the creation of partial liver grafts used to treat pediatric recipients with grafts from adult donors. In this study we reviewed the results of application of these techniques in 60 patients undergoing major hepatectomy and in 47 liver transplants in children. METHODS: Records of patients undergoing resection and children undergoing transplantation were reviewed. A descriptive study was performed characterizing the methods and results achieved using anatomic hepatectomy. Outcomes analyzed included surgical morbidity and survival. RESULTS: Sixty consecutive patients underwent major hepatectomy without operative mortality (60 days). Complications occurred in 26% of patients, requiring reoperation in 2 cases (3%); median hospital stay was 8.5 days. Of 47 liver transplants in children, 57% utilized partial grafts, and living donors were used in 15 cases. Actual patient survival is 91% 1-36 months after surgery. No patient deaths were due to technical graft failure. CONCLUSIONS: Major hepatic surgery can be accomplished with low mortality applying portal-based anatomy. Surgical precision is made possible by vascular isolation for hepatectomy and operative ultrasonography. These principles are essential for successful use of partial liver grafts in children.
BACKGROUND: Anatomical resection has become the basis for the treatment of hepatic tumors recognizing the portal-based intrahepatic architecture of the liver. In transplantation, these principles have been applied to the creation of partial liver grafts used to treat pediatric recipients with grafts from adult donors. In this study we reviewed the results of application of these techniques in 60 patients undergoing major hepatectomy and in 47 liver transplants in children. METHODS: Records of patients undergoing resection and children undergoing transplantation were reviewed. A descriptive study was performed characterizing the methods and results achieved using anatomic hepatectomy. Outcomes analyzed included surgical morbidity and survival. RESULTS: Sixty consecutive patients underwent major hepatectomy without operative mortality (60 days). Complications occurred in 26% of patients, requiring reoperation in 2 cases (3%); median hospital stay was 8.5 days. Of 47 liver transplants in children, 57% utilized partial grafts, and living donors were used in 15 cases. Actual patient survival is 91% 1-36 months after surgery. No patientdeaths were due to technical graft failure. CONCLUSIONS: Major hepatic surgery can be accomplished with low mortality applying portal-based anatomy. Surgical precision is made possible by vascular isolation for hepatectomy and operative ultrasonography. These principles are essential for successful use of partial liver grafts in children.