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

Table 1 Characteristics and results of studies on central hepatectomy (1983-2013) n (%)

Ref.	Year	n	Diagnosis	Operative time (min)	Vascular control	Blood loss (mL)	Morbidity	Mortality	Survival outcome
Hasegawa et al[27]	1989	16	HCC, CRM	300-660	Pedicle occlusion	600-7500	7 (50)	1 (6)	Median OS 34 mo
Makuuchi et al[28]	1993	17	HCC, CCA, CRM	412	NA	1482	7 (41.1)	1 (5.8)	NA
Nagino et al[29]	1998	15	Hilar CCA	NA	NA	NA	NA	NA	NA
Wu et al[17]	1999	15	HCC	474	Pringle’s maneuver or pedicle occlusion	2450	3 (20)	0 (0)	1-yr OS 67%	1-yr DFS 53%
									3-yr OS 44%	3-yr DFS 31%
									6-yr OS 30%	5-yr DFS 21%
Scudamore et al[19]	2000	18	HCC, CRM, GBC	238	Pringle’s maneuver	914	11 (61.1)	0 (0)	NA	NA
Yamashita et al[30]	2001	16	HCC, CCA, metastases, hemangioma, others	NA	NA	NA	NA	NA	NA	NA
3Jarnagin et al[3]	2002	15	Benign and malignant lesions	NA	NA	NA	NA	NA	NA	NA
Wu et al[22]	2002	58	HCC, CCA, metastases	409	Total hepatic flow clamping (28 patients)	1685	8 (8.5)	0 (0)	NA	NA
				399	Selective clamping of ipsilateral blood flow (30 patients)	1159	10 (33.3)	0 (0)	NA	NA
Hu et al[23]	2003	52	HCC	265	NA	1030	9 (17)	0 (0)	Median OS 51 mo	Median DFS 23 mo
Chouillard et al[25]	2003	19	HCC, metastases, CCA, benign tumor	280	Pringle’s maneuver ± hepatic vein clamping	NA	NA	0 (0)	NA	NA
1Chen et al[18]	2006	118	HCC	128	Pringle’s maneuver ± IVC occlusion	592	36 (30.5)	1 (0.8)	NA	NA
Kim et al[31]	2006	35	HCC, CCA, hepatic sarcoma	331	Extraglissonian approach and parenchymal Kelly crushing	516	2 (5.7)	1 (2.8)	1-yr OS 94%	NA
									2-yr OS 72%
									5-yr OS 62%
Giuliante et al[32]	2007	18	HCC, metastases	448	Intermittent pedicle clamping	NA	6 (33.3)	0 (0)	NA	NA
1Chen et al[33]	2007	246	HCC	177 (with preoperative TACE)	Pringle’s maneuver ± IVC control	790	31 (34.8)	3 (3.4)	1-yr OS 87.1%	1-yr DFS 75%
									3-yr OS 62.9%	3-yr DFS 46.2%
									5-yr OS 46.2%	5-yr DFS 31.8%
				115 (without)		420	38 (24.2)	1 (0.6)	1-yr OS 82.2%	1-yr DFS 69.6%
									3-yr OS 54.4%	3-yr DFS 38%
									5-yr OS 31.7%	5-yr DFS 16.5%
1Chen et al[7]	2008	256	HCC	174	Pringle’s maneuver ± IVC control	750 (Pringle only); 380 (Pringle with IVC control)	72 (28.1)	1 (0.4)	1-yr OS 77.0%	1-yr DFS 59.1%
									3-yr OS 49.8%	3-yr DFS 28.8%
									5-yr OS 35.1%	5-yr DFS 17.0%
Mehrabi et al[34]	2008	48	HCC, metastases, CCA, GBC, hemangioma, other	238	Pringle’s maneuver in 9 patients	1120	13 (27.1)	1 (2)	NA	3-yr DFS 47.9%
Lee et al[20]	2008	27	HCC	330	Pedicle ligation	1400	12 (44.4)	2 (7.9)	NA	NA
Arkadopoulos et al[35]	2012	36	HCC, metastases	180	Selective hepatic vascular exclusion/Pringle’s maneuver (16 patients)	650	6 (37.5)	0 (0)	NA	NA
				150	Sequential hemihepatic vascular control (20 patients)	400	9 (45)	0 (0)	NA	NA
Gallagher et al[36]	2013	21	HCC	627	Intermittent Pringle’s maneuver	1590	4 (19)	1 (4.8)	1-yr OS 90.5%	1-yr DFS 65%
									3-yr OS 66.8%	3-yr DFS 34.8%
									5-yr OS 66.8%	5-yr DFS 34.8%
Cheng et al[8]	2012	63	HCC	230	Pringle’s maneuver	500	8 (12.7)	5 (7.9)	1-yr OS 87.5%	1-yr DFS 50%
									5-yr OS 53.1%	5-yr DFS 15%
3Yang et al[37]	2013	150	HCC	NA	Pringle maneuver	NA	NA	NA	NA
Total number		8952	range	115-627		380-2450	Overall morbidity: 27.5%	Overall mortality: 2.3%
							(range: 12.7%-61.1%)	(range: 0%-7.1 %)

¹Indicates multiple studies with overlapping study periods from a single institution;

²Total number calculated after excluding studies with repeat patients;

³Limited data available as CH patients were a subset of a larger group of patients undergoing various types of hepatic resections. Overall morbidity and mortality was calculated by considering the number of events as a percentage of the total number of patients in included studies. HCC: Hepatocellular carcinoma; CRM: Colorectal metastases; CCA: Cholangiocarcinoma; GBC: Gallbladder carcinoma; IVC: Inferior vena cava; NA: Not available; OS: Overall survival; DFS: Disease-free survival; TACE: Transarterial chemoembolization; CH: Central hepatectomy.