AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed...AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed in MEDLINE for articles published from January1983 to June 2013 to evaluate the evidence for andagainst CH in the management of central hepatic malig-nancies and to compare the perioperative variables andoutcomes of CH to lobar/extended hemihepatectomy. RESULTS: A total of 895 patients were included from21 relevant studies. Most of these patients who un-derwent CH were a sub-cohort of larger liver resectionstudies. Only 4 studies directly compared Central vshemi-/extended hepatectomies. The range of opera-tive time for CH was reported to be 115 to 627 min andPringle's maneuver was used for vascular control in themajority of studies. The mean intraoperative blood lossduring CH ranged from 380 to 2450 mL. The reportedmorbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mor-tality ranged from 0.0% to 7.1% with an overall mor-tality of 2.3% following CH. The 1-year overall survival(OS) for patients underwent CH for hepatocellular car-cinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserv-ing procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.展开更多
Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(P...Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four(16.7%) in the EH group( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min(290–840) vs. 523 min(310–860), P = 0.328], intraoperative blood loss [850 mL(40 0–150 0) vs. 650 mL(10 0–20 0 0), P = 0.746] or patients requiring intraoperative blood transfusion [1(9.1%) vs. 7(30.4%), P = 0.227]. There was a trend towards fewer hepatectomyspecific complications in the CH group [3(27.3%) vs. 13(54.2%), P = 0.167], including PHLF(CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days(5–23) vs. 12 days(4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.展开更多
文摘AIM: To study whether central hepatectomy(CH) canachieve similar overall patient survival and disease-freesurvival rates as conventional major hepatectomies ornot.METHODS: A systematic literature search was per-formed in MEDLINE for articles published from January1983 to June 2013 to evaluate the evidence for andagainst CH in the management of central hepatic malig-nancies and to compare the perioperative variables andoutcomes of CH to lobar/extended hemihepatectomy. RESULTS: A total of 895 patients were included from21 relevant studies. Most of these patients who un-derwent CH were a sub-cohort of larger liver resectionstudies. Only 4 studies directly compared Central vshemi-/extended hepatectomies. The range of opera-tive time for CH was reported to be 115 to 627 min andPringle's maneuver was used for vascular control in themajority of studies. The mean intraoperative blood lossduring CH ranged from 380 to 2450 mL. The reportedmorbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mor-tality ranged from 0.0% to 7.1% with an overall mor-tality of 2.3% following CH. The 1-year overall survival(OS) for patients underwent CH for hepatocellular car-cinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively. CONCLUSION: Based on current literature, CH is a promising option for anatomical parenchymal-preserv-ing procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.
基金Pancare Foundation ( www.pancare.org.au ) for supporting hepatobiliary pancreatic cancer research in the Department of Surgery
文摘Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four(16.7%) in the EH group( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min(290–840) vs. 523 min(310–860), P = 0.328], intraoperative blood loss [850 mL(40 0–150 0) vs. 650 mL(10 0–20 0 0), P = 0.746] or patients requiring intraoperative blood transfusion [1(9.1%) vs. 7(30.4%), P = 0.227]. There was a trend towards fewer hepatectomyspecific complications in the CH group [3(27.3%) vs. 13(54.2%), P = 0.167], including PHLF(CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days(5–23) vs. 12 days(4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.
