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Outcomes of central hepatectomy versus extended hepatectomy

Hepatobiliary & Pancreatic Diseases International 2019年第3期18卷 249-254页

作者： Jenny Chan luke bradshaw Nezor Houli Laurence Weinberg Marcos V Perini Michael Fink Vijayaragavan Muralidharan Graham Starkey Robert Jones Bao Zhong Wang Christopher Christophi Mehrdad Nikfarjam Department of Surgery University of Melbourne Austin Health Heidelberg Melbourne Victoria Australia Department of Surgery University of Melbourne Northern Health Epping Victoria Australia Department of Anaesthesia University of Melbourne Austin Health Heidelberg Melbourne Victoria Australia

Background: Central hepatectomy(CH) is more difficult than extended hepatectomy(EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent posthepatectomy liver failure(PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four(16.7%) in the EH group( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min(290–840) vs. 523 min(310–860), P = 0.328], intraoperative blood loss [850 mL(40 0–150 0) vs. 650 mL(10 0–20 0 0), P = 0.746] or patients requiring intraoperative blood transfusion [1(9.1%) vs. 7(30.4%), P = 0.227]. There was a trend towards fewer hepatectomyspecific complications in the CH group [3(27.3%) vs. 13(54.2%), P = 0.167], including PHLF(CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days(5–23) vs. 12 days(4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.

关键词： Central hepatectomy Mesohepatectomy Central bisectionectomy Central bisegmentectomy Extended hepatectomy

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