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©2014 Baishideng Publishing Group Inc.
World J Hepatol. May 27, 2014; 6(5): 347-357
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.347
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.347
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 %) |
Table 2 Summary of case-control studies comparing central hepatectomies and lobar/extended hepatectomies n (%)
Ref. | Year | Resection type | n | Operative time (min) | Blood loss (mL) | Mortality | Morbidity | Complications (n) |
Wu et al[17] | 1999 | Central hepatectomy | 15 | 474 | 2450 | 0 (0) | 3 (20) | Bile leak (1), pleural effusion (1), ascites (1) |
Extended hepatectomy | 25 | 348 | 1863 | 1 (4) | 6 (24) | Bile Leak (2), pleural effusion (1), ascites (1), prolonged jaundice (2), intra-abdominal abscess (2), wound infection (1) | ||
P value | 0.09 | 0.23 | 0.43 | 0.99 | - | |||
Scudamore et al[19] | 2000 | Central hepatectomy | 18 | 238 | 914 | 0 (0) | 1intra (5.5) | Intraoperative bleeding (1), pneumonia (2), intra-abdominal fluid collection (2), fever longer than 48 hours (2), transient fever (2), bile leak (1), late intra-abdominal fluid collection (1) |
Lobar hepatectomy | 71 | 222 | 1025 | 1 (1.4) | 9early (50) | NA | ||
1late (5.6) | ||||||||
6intra (8.5) | ||||||||
29early (40.8) | ||||||||
3late (4.2) | ||||||||
Extended hepatectomy | 43 | 304 | 1628 | 0 (0) | 2intra (4.7) | NA | ||
21early (48.9) | ||||||||
9late (20.9) | ||||||||
P value | < 0.001 | 0.009 for extended vs central | - | 0.05 for late complications | - | |||
Hu et al[23] | 2003 | Central hepatectomy | 52 | 265 | NA | 0 (0) | 9 (17) | Bile leak (3), pleural effusion (3), 1 postoperative massive ascites (1), subphrenic abscess (1) |
Conventional or extended hepatectomy | 63 | 264 | NA | 2 (3.1) | 12 (19) | Bile leak (2), wound infection (4), pneumonia (2), liver failure (2), subphrenic abscess (1), pleural effusion (1) | ||
P value | 0.953 | 0.408 | 0.491 | - | ||||
Cheng et al[8] | 2012 | Central hepatectomy | 63 | 230 | 500 | 5 (7.9) | 8 (12.7) | Liver failure (2), bile leak (1)1 |
Hemi-/extended hepatectomies | 41 | 316 | 750 | 3 (7.3) | 6 (14.6) | Liver failure (2), bile leak (1) | ||
P value | < 0.001 | 0.004 | 1.000 | 0.777 | - | |||
Total | Central hepatectomy | 148 | Mean 268 | Mean 882 | 3.4% (0%-7.9%) | 20.90% (range: 20%-66.7%) | ||
Hemi-/extended hepatectomies | 243 | Mean 299 | Mean 1352 | 2.9% (0%-7.3%) | 38.70% (range: 14.6%-74.4% ) |
Table 3 Type and frequency of complications reported following central hepatectomy
Type of complication1 | Number reported (n = 200) | Frequency (%) |
Surgical complications | ||
Bile leakage/biloma | 36 | 18 |
Intra-abdominal abscess | 16 | 8 |
Wound infection | 7 | 3.5 |
Bleeding | 4 | 2 |
Intestinal perforation | 1 | 0.5 |
Medical complications | ||
Pleural effusion/empyema | 62 | 31 |
Ascites | 29 | 14.5 |
Pneumonia/pulmonary infection | 13 | 6.5 |
Pulmonary edema | 6 | 3 |
Fever | 4 | 2 |
Upper gastrointestinal bleeding | 3 | 1.5 |
Urinary tract infection | 3 | 1.5 |
Transient hepatic dysfunction/ prolonged jaundice | 3 | 1.5 |
Hepatic necrosis/liver failure | 3 | 1.5 |
Acute renal failure | 2 | 1 |
Stroke | 1 | 0.5 |
Arrhythmia | 1 | 0.5 |
Deep vein thrombosis | 1 | 0.5 |
Other (not specified) | 4 | 2 |
- Citation: Lee SY. Central hepatectomy for centrally located malignant liver tumors: A systematic review. World J Hepatol 2014; 6(5): 347-357
- URL: https://www.wjgnet.com/1948-5182/full/v6/i5/347.htm
- DOI: https://dx.doi.org/10.4254/wjh.v6.i5.347