Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

Shinke, Go; Noda, Takehiro; Eguchi, Hidetoshi; Iwagami, Yoshifumi; Yamada, Daisaku; Asaoka, Tadafumi; Kikuchi, Kôichi; Gotoh, Kunihito; Kobayashi, Shogo; Takeda, Yutaka; Tanemura, Masahiro; Mizushima, Tsunekazu; Umeshita, Koji; Doki, Yuichiro; Mori, Masaki

doi:10.3892/mco.2018.1632

Cited by 8 publications

(22 citation statements)

References 27 publications

(31 reference statements)

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“…Comparative studies assessing outcomes of MLRs are scarce, 7,27 and the available data regarding perioperative morbidity and In our series, overall morbidity was 41.5% in MLR group, not significantly different from isolated hepatectomy group (31.1%). This finding was reported by some authors, 7,9 but others found higher morbidity in combined resections. 10,27 Despite no difference in overall morbidity, our results confirm that MLRs are major procedures associated with longer operative time, higher blood loss, and longer hospital stay when compared with well-matched controls submitted to similar liver resections, which is in accordance to previously published data.…”

Section: Discussionsupporting

confidence: 84%

“…[16][17][18][19] In a recent study, Dias et al 20 MLRs are rare procedures even in high-volume centers, with frequencies varying from 1% to 11.2%. 7,9,12,24 Hand et al 7 are used in the literature: "multivisceral," "multiorgan," or "extended resection." 5,9 Keeping in mind the limitations and impropriety of the term, as not only "visceras" (eg, VCI and diaphragm) were included in MLR group, we choose de term "multivisceral" since it is the most commonly employed in the literature.…”

Section: Subgroup Analysismentioning

confidence: 99%

“…7,9,12,24 Hand et al 7 are used in the literature: "multivisceral," "multiorgan," or "extended resection." 5,9 Keeping in mind the limitations and impropriety of the term, as not only "visceras" (eg, VCI and diaphragm) were included in MLR group, we choose de term "multivisceral" since it is the most commonly employed in the literature. 7,19,22 In face of a lack of standard definition of MLRs, some studies included non en-bloc liver resections, 5,10 resulting in heterogeneous cohorts.…”

Section: Subgroup Analysismentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Júnior

Coelho

Tustumi

et al. 2020

Journal of Surgical Oncology

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Background: En bloc liver and adjacent organs resections are technically demanding procedures. Few case series and nonmatched comparative studies reported the outcomes of multivisceral liver resections (MLRs). Objectives: To compare the short and long-term outcomes of patients submitted MLRs with those submitted to isolated hepatectomies. Methods: From a prospective database, a case-matched 1:2 study was performed comparing MLRs and isolated hepatectomy. Additionally, a risk analysis was performed to evaluate the association between MLRs and perioperative morbidity, mortality, and long-term survival. Results: Fifty-three MLRs were compared with 106 matched controls. Patients undergoing MLRs had longer operative time (430 [320-525] vs 360 [270-440] minutes,

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Section: Discussionsupporting

confidence: 84%

Section: Subgroup Analysismentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Júnior

Coelho

Tustumi

et al. 2020

Journal of Surgical Oncology

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“…Nevertheless, the rates of laparoscopic and robotic major liver resections have increased, and controlling blood loss during these minimally invasive surgeries is difficult; to address this, several studies have recently been published to introduce different methods of the PM in laparoscopic or robotic surgeries [16][17][18] . In addition, the risk of intraoperative bleeding, perioperative blood infusion, postoperative complications, and mortality after EH are still considerable 5,24,25 .…”

Section: Discussionmentioning

confidence: 99%

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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Despite the ongoing decades-long controversy, pringle maneuver (pM) is still frequently used by hepatobiliary surgeons during hepatectomy. The aim of this study was to investigate the effect of PM on intraoperative blood loss, morbidity, and posthepatectomy hemorrhage (PHH). A series of 209 consecutive patients underwent extended hepatectomy (eH) (≥5 segment resection). The association of pM with perioperative outcomes was evaluated using multivariate analysis with a propensity score method to control for confounding. Fifty patients underwent PM with a median duration of 19 minutes. Multivariate analysis revealed that risk of excessive intraoperative bleeding (≥1500 ml; odds ratio [OR] 0.27, 95%-confidence interval [CI] 0.10-0.70, p = 0.007), major morbidity (OR 0.41, 95%-CI 0.18-0.97, p = 0.041), and PHH (OR 0.22, 95%-CI 0.06-0.79, p = 0.021) were significantly lower in PM group after EH. Furthermore, there was no significant difference in 3-year recurrence-free-survival between groups. pM is associated with lower intraoperative bleeding, pHH, and major morbidity risk after eH. Performing PM does not increase posthepatectomy liver failure and does not affect recurrence rate. Therefore, PM seems to be justified in EH. Extended hepatectomy (EH) is the only curative treatment option for patients with large primary or bilobar metastatic liver malignancies 1. Better patient selection and developments in surgical techniques and instruments have increased the number and safety of EH 2,3. However, the risk of complications such as intraoperative bleeding, especially in patients with large tumors or tumors near to major vessels, is still high. These factors are associated with poorer postoperative outcomes 4,5. Patients with massive intraoperative blood loss have a higher rate of posthepatectomy morbidity and mortality 2 and lower recurrence-free survival due to blood transfusion 6. Therefore, reducing intraoperative bleeding during EH and reducing the amount of blood products transfused are important points in liver surgery. Despite the ongoing controversy regarding the advantages and disadvantages of hepatic inflow control during hepatectomy, the Pringle maneuver (PM) remains the most commonly used and evidence-based method of hepatic inflow control 7. The PM significantly decreases intraoperative blood loss, the amount of blood products transfused, and operation time, especially when performed in combination with low central venous pressure 8-10. Nevertheless, there is no evidence that the PM can reduce posthepatectomy morbidity and mortality 11,12 ; in fact, the PM may result in ischemia-reperfusion injury of the liver, which negatively affects hepatocyte metabolism, thereby increasing the rate of posthepatectomy liver failure (PHLF) 13,14. Despite several studies investigating the role of the PM in liver resection, the effects of the PM on intra-and postoperative outcomes have not been investigated exclusively in EH, which has a higher risk of intraoperative bleeding than minor hepatectomies 15. In addition, applica...

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Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

Baimas-George

Tschuor

Watson

et al. 2020

Langenbecks Arch Surg

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Purpose: Historically, invasion of the inferior vena cava (IVC) represented advanced and often unresectable hepatic disease. With surgical and anesthetic innovations, IVC resection and reconstruction have become feasible in selected patients. This review assesses technical variations in reconstructive techniques and post-operative management. Methods: A comprehensive literature search was performed according to PRISMA. Inclusion criteria were (i) peer-reviewed articles in English; (ii) at least three cases; (iii) hepatic IVC resection and reconstruction (January 2015-March 2020). Primary outcomes were reconstructive technique, anti-thrombotic regimen, post-operative IVC patency, and infection. Secondary outcomes included post-operative complications and malignant disease survival. Results: Fourteen articles were included allowing for investigation of 351 individual patients. Analysis demonstrated significant heterogeneity in surgical reconstructive technique, anti-thrombotic management, and postoperative monitoring of patency. There was increased utilization of ex vivo approaches and decreased use of venovenous bypass compared with previously published reviews. Conclusion: This review of literature published between 2015 and 2020 reveals persistent heterogeneity of hepatic IVC reconstructive techniques and peri-operative management. Increased utilization of ex vivo approaches and decreased use of venovenous bypass point towards improved operative techniques, peri-operative management, and anesthesia. In order to gain evidence for consensus on management, a registry would be beneficial.

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Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

Cited by 8 publications

References 27 publications

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

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

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Current trends in vena cava reconstructive techniques with major liver resection: a systematic review

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