Is extended hepatectomy for hepatobiliary malignancy justified?

被引:254
作者
Vauthey, JN
Pawlik, TM
Abdalla, EK
Arens, JF
Nemr, RA
Wei, SH
Kennamer, DL
Ellis, LM
Curley, SA
机构
[1] Univ Texas, MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USA
[2] Univ Texas, MD Anderson Canc Ctr, Dept Anesthesiol, Houston, TX 77030 USA
关键词
D O I
10.1097/01.sla.0000124385.83887.d5
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Extended hepatectomy may be required to provide the best chance for cure of hepatobiliary malignancies. However, the procedure may be associated with significant morbidity and mortality. Methods: We analyzed the outcome of 127 consecutive patients who underwent extended hepatectomy (resection of greater than or equal to 5 liver segments) for hepatobiliary malignancies. Results: The patients underwent extended hepatectomy for colorectal metastases (n = 86; 67.7%), hepatocellular carcinoma (n = 12; 9.4%), cholangiocarcinoma (n = 14; 11.0%), and other malignant diseases (n =15; 11.5%). Thirty-two left and ninety-five right extended hepatectomies were performed. Eight patients also underwent caudate lobe resection, and 40 patients underwent a synchronous intraabdominal procedure. Twenty patients underwent radio-frequency ablation, and 31 under-went preoperative portal vein embolization. The median blood loss was 300 mL for right hepatectomy and 600 mL for left hepatectomy (P = 0.02). Thirty-six patients (28.3%) received a blood transfusion. The overall complication rate was 30.7% (n 39), and the operative mortality rate was 0.8% (n = 1). Significant liver insufficiency (total bilirubin level > 10 mg/dL or international normalized ratio > 2) occurred in 6 patients (4.7%). Multivariate analysis showed that a synchronous intraabdominal procedure was the only factor associated with an increased risk of morbidity (hazard ratio [HR], 4.9; P = 0.02). The median survival was 41.9 months. The overall 5-year survival rate was 25.5%. Conclusions: Extended hepatectomy can be performed with a near-zero operative mortality rate and is associated with long-term survival in a subset of patients with malignant hepatobiliary disease. Combining extended hepatectomy with another intraabdominal procedure increases the risk of postoperative morbidity.
引用
收藏
页码:722 / 730
页数:9
相关论文
共 49 条
[21]  
LORTAT-JACOB J L, 1952, Arch Mal Appar Dig Mal Nutr, V41, P662
[22]   Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for major liver resection for hepatobiliary malignancy: Safety and effectiveness - Study in 26 patients [J].
Madoff, DC ;
Hicks, ME ;
Abdalla, EK ;
Morris, JS ;
Vauthey, JN .
RADIOLOGY, 2003, 227 (01) :251-260
[23]  
MAKUUCHI M, 1991, HEPATO-GASTROENTEROL, V38, P176
[24]  
MAKUUCHI M, 1990, SURGERY, V107, P521
[25]   Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J].
Man, K ;
Fan, ST ;
Ng, IOL ;
Lo, CM ;
Liu, CL ;
Wong, J .
ANNALS OF SURGERY, 1997, 226 (06) :704-711
[26]   The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: Is there a standard for transfusion? [J].
Martin, RCG ;
Jarnagin, WR ;
Fong, Y ;
Biernacki, P ;
Blumgart, LH ;
DeMatteo, RP .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2003, 196 (03) :402-409
[27]   OCCURRENCE OF INTRAPERITONEAL SEPTIC COMPLICATIONS AFTER HEPATIC RESECTIONS BETWEEN 1985 AND 1990 [J].
MATSUMATA, T ;
YANAGA, K ;
SHIMADA, M ;
SHIRABE, K ;
TAKETOMI, A ;
SUGIMACHI, K .
SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY, 1995, 25 (01) :49-54
[28]   Extended hepatic resection: A 6-year retrospective study of risk factors for perioperative mortality [J].
Melendez, J ;
Ferri, E ;
Zwillman, M ;
Fischer, M ;
DeMatteo, R ;
Leung, D ;
Jarnagin, W ;
Fong, Y ;
Blumgart, LH .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2001, 192 (01) :47-53
[29]   RIGHT OR LEFT TRISEGMENT PORTAL-VEIN EMBOLIZATION BEFORE HEPATIC TRISEGMENTECTOMY FOR HILAR BILE-DUCT CARCINOMA [J].
NAGINO, M ;
NIMURA, Y ;
KAMIYA, J ;
KONDO, S ;
UESAKA, K ;
KIN, Y ;
KUTSUNA, Y ;
HAYAKAWA, N ;
YAMAMOTO, H .
SURGERY, 1995, 117 (06) :677-681
[30]   Liver regeneration after major hepatectomy for biliary cancer [J].
Nagino, M ;
Ando, M ;
Kamiya, J ;
Uesaka, K ;
Sano, T ;
Nimura, Y .
BRITISH JOURNAL OF SURGERY, 2001, 88 (08) :1084-1091