Outcomes of extended hepatectomy for hepatobiliary tumors. Initial experience from a non-university hepatobiliary center

Attili, Abdelrahman; Sucandy, Iswanto; Spence, Janelle; Bourdeau, Timothy J.; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1016/j.amjsurg.2019.05.007

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…To decrease the risk of PHLF, liver volume augmentation was used in six cases with low FLR. The PHLF rate in a recent study was 20% which is lower than that observed in this study (35.3%) [ 17 ]. On subgroup analysis, PHLF was significantly higher in the augmentation group compared to the no augmentation group (4 vs 2, p = 0.045).…”

Section: Discussioncontrasting

confidence: 80%

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Early Outcomes of Extended Hepatectomy: An Experience from the University Hospital of Nepal

Sharma¹,

Adhikari²,

Maharjan³

et al. 2023

Cureus

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BackgroundExtended hepatectomy (≥ 5 liver segments resection) may be required to have a complete surgical resection and provide the best chance of cure of hepatobiliary tumors. It is associated with high morbidity and mortality but with good perioperative care, its outcomes can be improved. This study was conducted to evaluate the early outcomes of extended hepatectomy at a university hospital in Nepal. MethodsFor this study, prospectively collected data from all patients who underwent extended hepatectomy from October 2012 to April 2022 were reviewed and analyzed retrospectively. Demographic data, liver volume augmentation methods used, intraoperative variables, and postoperative complications were analyzed. ResultsSeventeen patients underwent extended hepatectomy from October 2012 to April 2022. Among them 11 (64.7%) were female and the mean age was 53.9 ±16.3 years (18-72 years). Right extended hepatectomy was the most commonly performed procedure (n = 15, 88.2%), and left extended hepatectomy was performed in the remaining (n = 2, 11.8%). Six patients underwent liver volume augmentation procedures (35.3%) with portal vein embolization (PVE) in three, portal vein ligation (PVL) in one, and partial associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in two patients. Overall complications were 70% with major complications (Clavien Dindo ≥ IIIa) constituting 35.3%. The most common hepatectomy-specific complication was post-hepatectomy liver failure (PHLF) in six cases. The 30-day mortality was 17.6% (three patients). ConclusionExtended hepatectomy can be performed with acceptable major complications and mortality rates in selected patients.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 74%

Early Outcomes of Extended Hepatectomy: An Experience from the University Hospital of Nepal

Sharma¹,

Adhikari²,

Maharjan³

et al. 2023

Cureus

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“…[ 1 ] Partial hepatectomy (PHx) is currently the main clinical treatment for liver cancer [ 2 ] ; however, the incidence of perioperative liver failure, which is the most serious complication and main cause of death, is 1.2%–11.0% and is closely related to “small‐for‐size” syndrome following major hepatectomy. [ 3 , 4 ] Living donor liver transplantation (LDLT) also requires that PHx be conducted, but in healthy persons, and hence it is of utmost importance to ensure donors’ safety. [ 5 ] Unfortunately, morbidity and mortality rates are 10%–21% and 0.18%–0.50%, respectively, partly attributable to insufficient remnant functional liver volume.…”

Section: Introductionmentioning

confidence: 99%

C‐C motif chemokine ligand 5 confines liver regeneration by down‐regulating reparative macrophage‐derived hepatocyte growth factor in a forkhead box O 3a–dependent manner

et al. 2022

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Background and Aims: Liver regeneration (LR) is vital for the recovery of liver function after hepatectomy. Limited regeneration capacity, together with insufficient remnant liver volume, is a risk factor for posthepatectomy liver failure (PHLF) resulting from small-for-size syndrome. Although inflammation plays an important role in controlling LR, the underlying mechanisms still remain obscure. Approach and Results:We identified C-C motif chemokine ligand (CCL) 5 as an important negative regulator for LR. CCL5 levels were elevated after partial hepatectomy (PHx), both in healthy donors of living donor liver transplantation (LT) and PHx mouse models. Ccl5 knockout mice displayed

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“…Clinically, surgical resection remains a critical treatment option for many patients with primary and secondary hepatic neoplasms [6]. Extended hepatectomy (eHx) may be required for some patients with large tumors, which could cause fatal postoperative complications, including liver failure and death [7,8]. In fact, regeneration failure occurs frequently in patients with acute liver failure or after extensive liver resection [9].…”

Section: Introductionmentioning

confidence: 99%

Transcriptome sequencing and metabolome analysis reveal metabolic reprogramming of partial hepatectomy and extended hepatectomy

Peng

Chen

et al. 2023

Preprint

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Surgical resection remains a critical treatment option for many patients with primary and secondary hepatic neoplasms. Extended hepatectomy (eHx) may be required for some patients with large tumors, which may cause liver failure and individual death. Partial hepatectomy (pHx) and eHx mouse models were constructed, liver tissues were sampled at 18, 36, and 72 h post-hepatectomy, transcriptome and metabolome analyses were employed to find the differences in regeneration and injury between pHx and eHx. The results showed that eHx was associated with more severe liver injury and lower survival rates compared with pHx. Compared with the sham groups, transcriptomics data showed there were 1842, 2129, and 1277 differentially expressed genes (DEGs) in eHx and 962, 1305, and 732 DEGs in pHx at 18, 36, and 72 h post-hepatectomy, respectively. Compared with pHx, the number of DEGs reached a maximum of 230 at 18 h after surgery and decreased sequentially to 87 and 43 at 36 h and 72 h. Metabolomics analysis identified a total of 1399 metabolites, and 48 significant differentially produced metabolites (DPMs) were screened between eHx and pHx. Combined analysis of DEGs and DPMs indicated that cholesterol metabolism and insulin resistance may be two important pathways to liver regeneration and mouse survival post-extended hepatectomy. Our results showed the global influence of pHx and eHx on the transcriptome and metabolome in mouse liver, as both cholesterol metabolism and insulin resistance pathways were altered both at the transcriptional and metabolic levels between pHx and eHx groups.

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Outcomes of extended hepatectomy for hepatobiliary tumors. Initial experience from a non-university hepatobiliary center

Cited by 11 publications

References 16 publications

Early Outcomes of Extended Hepatectomy: An Experience from the University Hospital of Nepal

Early Outcomes of Extended Hepatectomy: An Experience from the University Hospital of Nepal

C‐C motif chemokine ligand 5 confines liver regeneration by down‐regulating reparative macrophage‐derived hepatocyte growth factor in a forkhead box O 3a–dependent manner

Transcriptome sequencing and metabolome analysis reveal metabolic reprogramming of partial hepatectomy and extended hepatectomy

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