Central hepatectomy for centrally located malignant liver tumors: A systematic review

Abstract

AIM:To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not. METHODS:A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy. RESULTS:A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle's maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity 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. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma 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-preserving 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.

Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

“…This volume decreases to 40–60% in patients with pre-existing parenchymal disease 20. This finding is consistent with multiple reports stating that ERH and a diminished FLR were significant and independent predictors for PHLF 2122232425. Kauffmann and Fong 21.…”

Central Hepatectomy for Biliary Cystadenoma: Parenchyma-Sparing Approach for Benign Lesions

“…No significant differences for postoperative morbidity and mortality between CH and extend hepatectomy (EH) were demonstrated by Lee's systematic review 4 . Additionally, a recent case-matched study from the same author showed no differences in 90-day mortality, biliary leaks and postoperative liver failure 4 . Moreover, this study also showed longer length of stay, higher postoperative bilirubin and longer prothrombine time for patients who underwent extend hepatectomy.…”

“…However, those concerns were not corroborated in comparative series of CH versus extend hepatectomy 4 . Moreover, CH presented shorter operative time (268 versus 299 min), and lower blood loss (882 vs. 1352 ml) when compared to extend hepatectomy.…”

“…Despite those concerns, this case highlighted that CH is safe and can be accomplished without significant morbidity. No significant differences for postoperative morbidity and mortality between CH and extend hepatectomy (EH) were demonstrated by Lee's systematic review 4 . Additionally, a recent case-matched study from the same author showed no differences in 90-day mortality, biliary leaks and postoperative liver failure 4 .…”

Modern Technical Approaches in Resectional Hepatic Surgery

“…Although segmental resections have an advantage in terms of tissue preservation, this must be weighed against increased blood loss and a considerable risk of biliary complications. 39,40 Furthermore, these resections are more frequently associated with positive margins and, depending on their location, may lead to inadvertent injury to important portal structures. In the case of a planned staged resection, such an injury may render the second operation impossible.…”