Left hepatic trisectionectomy for hepatobiliary malignancies: Its’ role and outcomes. A retrospective cohort study
| Autor: | T.R. Worthington, Ee Jun Ban, Marcos Kostalas, Rajesh Kumar, Rajiv P Lahiri, Nariman D. Karanjia, Nadeen Low, A. Riga, Adam E Frampton |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Transfusion rate
medicine.medical_specialty business.industry Mortality rate Incidence (epidemiology) Retrospective cohort study General Medicine Perioperative Neuroendocrine tumour Surgery Left hepatic trisectionectomy Colorectal liver metastases 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Extended left hepatectomy medicine Extensive resection 030211 gastroenterology & hepatology In patient Hepatobiliary business Original Research |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Background Left hepatic trisectionectomy (LHT) is a complex hepatic resection; its’ role and outcomes in hepatobiliary malignancies remains unclear. Materials and methods All patients undergoing LHT at the tertiary HPB referral unit at RSCH, Guildford, UK from September 1996 to October 2015 were included. Data were collected from a prospectively maintained database. Results Twenty-eight patients underwent LHT. The M:F ratio was 1.8:1. Median age was 60 years (range 43–76 years). Diagnoses included colorectal liver metastases (CRLM; n = 20); cholangiocarcinoma (CCA; n = 4); and other (neuroendocrine tumour metastases (NET; n = 3) and breast metastases (n = 1)). Median duration of surgery was 270 min (range 210–585 min). Median blood loss was 750 ml (300–2400 ml) with a perioperative transfusion rate of 21% (n = 6/28). The rate of all post-operative complications was 21% for all patients, and given the extensive resection performed four patients (14%) developed varying degrees of hepatic insufficiency. One patient with cholangiocarcinoma developed severe hepatic insufficiency, which was fatal within 90 days of surgery. 1 and 3-year survivals were 92% and 68% respectively. Conclusion This study supports LHT in patients with significant tumour burden. Despite extensive resection, our favourable morbidity and mortality rates show this is a safe and beneficial procedure for patients with all hepatobiliary malignancies. Given the nature of resection the incidence of post-operative hepatic insufficiency is higher than less extensive hepatic resections. Highlights • LHT is an extended resection reported to have higher incidences of morbidity and mortality compared with less extensive hepatic resections. • This procedure is useful for the surgical management of patients with hepatic lesions that were previously considered unresectable. • We report favourable outcomes following LHT at our institution compared with less extensive hepatic resections. • An initial post-operative lactate of >1.5 mmol/L was associated with an increased risk of developing post-operative complications (p = 0.035). |
| Databáze: | OpenAIRE |
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