Risk of Major Liver Resection in Patients With Underlying Chronic Liver Disease

Farges, Olivier; Malassagne, Benoı̂t; Fléjou, Jean François; Balzan, Silvio Márcio Pegoraro; Sauvanet, Alain; Belghiti, Jacques

doi:10.1097/00000658-199902000-00008

Cited by 288 publications

(208 citation statements)

References 16 publications

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“…LLR resulted in significantly less bleeding, shorter hospital stay, and fewer complications, with no difference in survival rates. In general, HCC, which is often accompanied by cirrhosis, has a high risk of postoperative complications such as ascites and liver failure 83. A meta‐analysis comparing the outcomes of LLR and OLR for HCC in patients with chronic liver disease reported favorable short‐term outcomes in the LLR group,84 which suggests that LLR results in fewer postoperative complications owing to factors such as less bleeding, a simpler mobilization procedure, and minimal destruction of the body wall 48.…”

Section: Indications and Oncological Outcomesmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

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Section: Indications and Oncological Outcomesmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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“…This result is consistent with our earlier observation that the early decrease in the PT after a right hepatectomy is comparable in patients with and without chronic liver disease. 27 A possible explanation is that although the PT is very sensitive to factor VII, 28 which has a short half-life and therefore decreases rapidly after a hepatectomy, it is also influenced by hemodilution 29 and patient temperature, 30 which may be very variable at the end of a major liver resection. The PT thereafter recovers rapidly in patients with a normal liver 27 -accordingly, PT had normalized in almost all of the patients in this study by postoperative day 5.…”

Section: S22mentioning

confidence: 99%

“…Bilirubin indeed has a longer half-life than the PT and therefore peaks between postoperative day 3 and 5 after a major hepatectomy. 27 At this later point postoperatively, plasma volume is normalizing and has a less significant impact on bilirubin. 31 Thus, the finding that serum bilirubin is inversely correlated with the volume of the remnant liver was expected.…”

Section: S22mentioning

confidence: 99%

The small remnant liver after major liver resection: How common and how relevant?

Yigitler¹

2003

Liver Transplantation

161

111

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The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from <30% to >60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was <60% in 94 patients (68%) including only 13 (9%) with RLV-FLV <30%. There was no linear correlation between the number of resected segments and the RLV-FLV. Postoperative serum bilirubin but not prothrombin time correlated with extent of resection. The incidence of complications including liver failure was not different among groups. Analysis of the four groups with a RLV-FLV ratio <60% showed a trend toward more complications and a longer intensive care unit stay in patients with the smallest RLVs. After major hepatectomy in patients with normal livers, the proportion of patients with a small remnant liver is low and not directly related to the number of segments resected. Although the rate of postoperative complications, including liver failure, did not directly correlate with the volume of remaining liver, the postoperative course was more difficult for patients with smaller remnants. Therefore preoperative portal vein embolization should be considered in patients who will undergo extended liver resection who have (1) injured liver or (2) normal liver when the planned procedure will be complex or when the anticipated RLV-FLV will be <30%. (Liver Transpl 2003;9:S18-S25.)

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“…PHLF is the standardized term to define the post-surgical acquired deterioration of the synthetics, excretory and detoxifying functions of the liver; this syndrome is characterized by an increase of the international normalized ratio values and of serum bilirubin levels from the fifth post-operative day [6] . This syndrome has a reported incidence of 1.2%-32% [7][8][9] . As mentioned above, the posthepatectomy mortality reported in recent years varies between 0% and 5% and the onset of PHLF remains the main cause [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

D’Onofrio

Robertis

Demozzi

et al. 2014

WJR

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The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

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Risk of Major Liver Resection in Patients With Underlying Chronic Liver Disease

Cited by 288 publications

References 16 publications

Evolution and revolution of laparoscopic liver resection in Japan

Evolution and revolution of laparoscopic liver resection in Japan

The small remnant liver after major liver resection: How common and how relevant?

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

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