Central hepatectomy versus extended hepatectomy for liver malignancy: a matched cohort comparison.

Journal Article (Journal Article)

Objective

To compare surgical outcomes between matched central hepatectomy (CH) and extended hepatectomy (EH) groups.

Background

Surgical choices for centrally located liver tumours are limited. The traditional EH harbours substantial risks, whereas CH is an alternative parenchymal-sparing resection that may improve peri-operative morbidity.

Methods

A review of 4661 liver resections at a single institution was performed. The cases (CH) were matched in a 1:1 ratio with EH controls.

Results

The CH group was matched for demographic, tumour and laboratory factors with either right EH or combined (right/left) EH groups (n = 63 per group). Colorectal liver metastases were the most common diagnosis occurring in 70% of the patients. Higher intra-operative blood loss was observed in the right EH(P = 0.01) and combined EH groups (P < 0.01) compared with the CH group. There was a trend towards lower 90-day morbidity in the CH group (43%) compared with the right EH(59%, P = 0.1) and combined EH groups (56%, P = 0.2). The length of hospital stay was significantly longer in the control groups (P < 0.01 for both). The control groups had significantly higher post-operative bilirubin and International Normalized Ratio (INR) levels compared with the CH group. A post-operative bilirubin higher than 4 mg/dl was observed in 2% of the CH group compared with 39% of the right EH group (P < 0.01) and 52% of the combined EH group (P < 0.01). No differences in the rates of bile leak/biloma, post-hepatectomy liver failure or 90-day mortality were found.

Conclusions

CH, as compared with EH, was safe and associated with a shorter hospital stay and less post-operative liver dysfunction. CH should be considered in patients with centrally located tumours amenable to such a resection.

Full Text

Duke Authors

Cited Authors

  • Lee, SY; Sadot, E; Chou, JF; Gönen, M; Kingham, TP; Allen, PJ; DeMatteo, RP; Jarnagin, WR; D'Angelica, MI

Published Date

  • November 2015

Published In

Volume / Issue

  • 17 / 11

Start / End Page

  • 1025 - 1032

PubMed ID

  • 26353922

Pubmed Central ID

  • PMC4605342

Electronic International Standard Serial Number (EISSN)

  • 1477-2574

International Standard Serial Number (ISSN)

  • 1365-182X

Digital Object Identifier (DOI)

  • 10.1111/hpb.12507

Language

  • eng