A Worldwide Survey of the Current Daily Practice in Liver Surgery

Abstract

Background: Liver resection remains the mainstay of curative treatment for liver malignancies. A variety of preoperative assessments and surgical techniques have improved the short- and long-term outcomes of liver resection in patients with liver tumors. Recently, laparoscopic hepatectomies have been increasingly performed. The aim of the present study is to survey the current practice of liver surgery in high-volume centers in the world. Methods: A questionnaire on the preoperative assessment for liver surgery, open hepatectomy, and laparoscopic hepatectomy was sent to 94 liver centers in the world. Results: Forty-two centers (45%) responded to this survey (29 Asian, 9 European, and 4 North American centers). All but one of the centers evaluated the future liver remnant (FLR) volume, and 95% of them performed preoperative portal vein embolization to increase the FLR volume. In half of the centers, the required FLR volume was over 30% in patients with normal liver and 50% in patients with cirrhotic liver. To reduce the intraoperative blood loss, half of the centers routinely used Pringle’s maneuver, and 85% restricted the intraoperative fluid infusion to reduce the central venous pressure. More than 10 laparoscopic hepatectomies were performed per year in 62% of the centers, and more than 30 were performed in 26%, respectively. Laparoscopic major hepatectomies were performed in 24%. Two-thirds answered that the laparoscopic approach would be feasible in donor hepatectomy. Conclusion: The evaluation of FLR volume in patients with normal or cirrhotic liver and the usage of preoperative portal vein embolization have become essential practice in more than 90% of the centers. Reduced blood loss has been achieved using Pringle’s maneuver, restriction of fluid infusion, and a variety of surgical devises. The laparoscopic approach is increasingly extended to major hepatectomy or donor hepatectomy.

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

“…Both groups of donors did not receive any blood transfusion peri-operatively. No significant between-group difference was observed in median (IQR [range]) hospital stay after operation: 11 (10-13 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]) days in the control vs 11 (10-13 [10][11][12][13][14][15][16][17][18][19][20]) days in the high SVV group, p = 0.621.…”

“…Although maintaining a low CVP SVV, stroke volume variation; INR, international normalised ratio; AST, aspartate aminotransferase; ALT, alanine aminotransferase; cGT, gamma-glutamyl transpeptidase. (≤ 5 mmHg) is frequently used to minimise blood loss during hepatectomy, this is considered controversial, especially in living liver donors [1,10,11,21,22]. For example, CVP was reported not to correlate with pre-load status in normal healthy volunteers [23], and several studies in living liver donors showed that CVP during hepatic resection was not associated with intraoperative blood loss [5,8,9,22].…”

Insufficient Ablative Margin Determined by Early Computed Tomography May Predict the Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

“…Radiofrequency ablation (RFA) has been accepted as an equivalent alternative to resection as an eradicative treatment for small HCC [2]. However, the local tumor progression (LTP) rate after RFA is higher than that after surgical resection [3,4]. Several studies have indicated that the incidence of LTP after RFA ranges from 2% to 18% [5,6].…”

Malignant Transformation of Hepatocellular Adenoma: How Frequently Does It Happen?

“…The total number of cases encountered was 63. Treatment was resection [1] in 40 cases, transcatheter arterial chemoembolization []2] in 2 cases, and careful follow-up in 21 cases. The ways in which diagnosis came about were as follows: tumor rupture (n = 4), incidental detection on screening (n = 25), referral from another hospital or clinic (n = 32), and other (n = 2).…”