Zero mortality in more than 300 hepatic resections: validity of preoperative volumetric analysis

Itoh, Shinji; Shirabe, Ken; Taketomi, Akinobu; Morita, Kazutoyo; Harimoto, Norifumi; Tsujita, Eiji; Sugimachi, Keizō; Yamashita, Yo Ichi; Gion, Tomonobu; Maehara, Yoshihiko

doi:10.1007/s00595-011-0108-2

Cited by 44 publications

(49 citation statements)

References 28 publications

(43 reference statements)

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“…In one of the previous studies based on an unselected series of 1005 liver resections performed in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw, overall morbidity and mortality rates were 22.1% and 1.4%, respectively . Although several studies have reported zero or near‐zero mortality after a liver resection, most of these report only in‐hospital or 30‐day rates . Of note, in‐hospital mortality was more than two‐fold lower compared with the 90‐day rate in the present series.…”

Section: Discussioncontrasting

confidence: 59%

Early post‐operative prediction of morbidity and mortality after a major liver resection for colorectal metastases

Grąt

Hołówko

Lewandowski

et al. 2013

HPB

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Section: Discussioncontrasting

confidence: 59%

Early post‐operative prediction of morbidity and mortality after a major liver resection for colorectal metastases

Grąt

Hołówko

Lewandowski

et al. 2013

HPB

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“…In the presence of a large and/or a deep seated tumor located in the central part of the liver (Couinaud segments 4,5,8), the resection is more technically challenging due to its proximity to important hilar structures. Central hepatectomy is more surgically daedalean than the conventional anatomical major liver resection because it has 2 resection planes instead of one, the need for preservation of the bilateral peripheral segments and its vasculature and the potential need for 2 bilioenteric anastomoses (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…With recent improvements in surgical techniques of liver resection, anesthesia and postoperative care, morbidity ranges from 5% to 25% and mortality has improved significantly and has approached zero [3][4][5][6] . Centrally located malignancies of the liver such as hepatocellular carcinoma (HCC), Cholangiocarcinoma (CCA) and liver metastases in segments 4, 5, 8 may require extensive resections because of their relationship to major vascular and biliary structures and deep location [7,8] .…”

Section: Introductionmentioning

confidence: 99%

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

Lee¹

2014

WJH

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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.

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“…These two imaging techniques in fact showed a very good accuracy in the estimation of the graft dimensions before transplant [31] and in providing a precise quantification of the pre-operative liver volumes [32][33][34] . Itoh et al [35] stated that the meticulous preoperative evaluation based on volumetric analysis of 3D CT images, together with improved surgical techniques, were fundamental to achieve "zero mortality" and minimized intraoperative blood loss in this 300 hepatic resections series. Regarding liver transplantation, Ringe et al [36] emphasized the role of CT, reporting that this method of imaging of the liver, in combination with dedicated software, plays a key role in the evaluation of candidates for liver donor transplantation: based on the results of liver CT volumetry, 31% of the candidates of this series were excluded as donors.…”

Section: Imaging: Which Modality Should Be Chosen?mentioning

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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Zero mortality in more than 300 hepatic resections: validity of preoperative volumetric analysis

Cited by 44 publications

References 28 publications

Early post‐operative prediction of morbidity and mortality after a major liver resection for colorectal metastases

Early post‐operative prediction of morbidity and mortality after a major liver resection for colorectal metastases

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

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

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