Associated liver and multivisceral resections: should we extend the frontiers of resectability?

Abstract

Combined liver and multivisceral resections (CLMVRs) are rare procedures that demand extensive surgical skills. Few reports have discussed the benefit of these complex procedures and their indications are poorly defined. The aim of the present study is to present short- and long-term results of CLMVRs in primary and metastatic malignancies, including a risk analysis for perioperative morbidity and mortality. A review of our prospective surgical database between November 2007 and August 2013 identified 21 patients who had undergone CLMVRs. Preoperative radiologic evaluation and laboratory data, intraoperative results, hospital outcomes, and long-term follow-up were analyzed. CLMVRs were performed due to metastatic disease from different sites in 17 patients, and due to direct local invasion of the liver in the remaining 4 cases. Major hepatectomy was performed in 7 cases. Morbidity was 57% and 90-day postoperative mortality was 9%. Gender and resection of more than 4 organs were found as statistically significant risk factors to develop major complications. Five of 7 patients with 4 or more organs resected presented major complications including mortality (p = 0.026). The overall 1- and 3-year survival rates were 57 and 24%, respectively. Patients undergoing CLMVRs experience acceptable postoperative morbidity and mortality rates. Surgery should be performed only in carefully selected patients, considering their preoperative comorbidities, and in high-volume centers.

Combined liver and multivisceral resections: A comparative analysis of short and long‐term outcomes

“…2,3 Risk factors related to perioperative mortality and morbidity are patient's clinical performance, preoperative liver function, extension of liver resection, as well as the simultaneous resection of other abdominal organs. 4,5 The largest experience with liver resection associated with other gastrointestinal organs comes from colorectal cancer with synchronous liver metastases. 6 Few studies have evaluated the results of hepatectomies associated with resection of adjacent organs (multivisceral liver resections [MLRs]).…”

“…6 Few studies have evaluated the results of hepatectomies associated with resection of adjacent organs (multivisceral liver resections [MLRs]). 5,7 The rationale of this procedure is that potentially curative treatment of primary liver neoplasms and certain liver metastases is possible when free surgical margins are obtained (R0 resection). 7,8 MLRs have been performed in centers of excellence in hepatobiliary surgery due to technical advances in liver surgery, better knowledge of liver and vascular anatomy, and improvements in perioperative care.…”

“…9 MLRs can be indicated for liver lesions with contiguous invasion of adjacent organs or tumors from other sites with direct invasion of the hepatic parenchyma, such as colonic, gastric, renal, or right suprarenal tumors. 5,8,10,11 Although feasible, the results and indications of MLRs remain unclear. There are few studies addressing this issue, and the available evidence comes mostly from small heterogeneous retrospective cohorts, 5,12 and few comparative studies.…”

Totally laparoscopic liver resection for colorectal metastasis located in Segment 7 in a patient withsitus inversus totalis

“…At the beginning of the introduction of LLR, one of the more frequent criticisms was that, because of a more challenging approach for anatomical segmentectomies, in most cases a non-anatomical resection is performed with thinner resection margins compared with open surgery [6]. However, even in the presence of reduced surgical margins, oncological results in the short- and long-term follow-ups are the same such as open surgery especially for colorectal liver metastasis [7].…”

The First Case Report of Robotic Multivisceral Resection for Synchronous Liver Metastasis from Pancreatic Neuroendocrine Tumor: A Case Report and Literature Review

“…48 In a hand of skillful and experienced robotic team, robotic multivisceral resection for PNET is feasible with optimal outcomes in well selected patients.…”