Erschienen in:
10.03.2016 | Research Article
Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence
verfasst von:
C. Codony, S. López-Ben, M. Albiol, L. Falgueras, E. Castro, A. Codina-Barreras, M. Casellas, J. Gil, A. Codina-Cazador, J. Figueras
Erschienen in:
Clinical and Translational Oncology
|
Ausgabe 11/2016
Einloggen, um Zugang zu erhalten
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.