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

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Abstract

Purpose

We reviewed a series of patients who underwent hepatic resection at our institution, to investigate the risk factors for postoperative complications after hepatic resection of liver tumors and for procurement of living donor liver transplantation (LDLT) grafts.

Methods

Between April 2004 and August 2007, we performed 304 hepatic resections for liver tumors or to procure grafts for LDLT. Preoperative volumetric analysis was done using 3-dimensional computed tomography (3D-CT) prior to major hepatic resection. We compared the clinicopathological factors between patients with and without postoperative complications.

Results

There was no operative mortality. According to the 3D-CT volumetry, the mean error ratio between the actual and the estimated remnant liver volume was 13.4%. Postoperative complications developed in 96 (31.6%) patients. According to logistic regression analysis, histological liver cirrhosis and intraoperative blood loss >850 mL were significant risk factors of postoperative complications after hepatic resection.

Conclusions

Meticulous preoperative evaluation based on volumetric analysis, together with sophisticated surgical techniques, achieved zero mortality and minimized intraoperative blood loss, which was classified as one of the most significant predictors of postoperative complications after major hepatic resection.

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References

  1. Shimada M, Takenaka K, Fujiwara Y, Gion T, Shirabe K, Yanaga K, et al. Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma. Br J Surg. 1998;85:195–8.

    Article  PubMed  CAS  Google Scholar 

  2. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.

    Article  PubMed  CAS  Google Scholar 

  3. Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg. 2007;204(4):580–7.

    Article  PubMed  Google Scholar 

  4. Hasegawa K, Kokudo N. Surgical treatment of hepatocellular carcinoma. Surg Today. 2009;39:833–43.

    Article  PubMed  Google Scholar 

  5. Takenaka K, Kawahara N, Yamamoto K, Kajiyama K, Maeda T, Itasaka H, et al. Results of 280 liver resections for hepatocellular carcinoma. Arch Surg. 1996;131:71–6.

    Article  PubMed  CAS  Google Scholar 

  6. Makuuchi M. Remodeling the surgical approach to hepatocellular carcinoma. Hepatogastroenterology. 2002;49:36–40.

    PubMed  Google Scholar 

  7. Belghiti J, Regimbeau JM, Durand F, Kianmanesh AR, Dondero F, Terris B, et al. Resection of hepatocellular carcinoma: a European experience on 328 cases. Hepatogastroenterology. 2002;49:41–6.

    PubMed  CAS  Google Scholar 

  8. Wei AC, Tung-Ping Poon R, Fan ST, Wong J. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg. 2003;90:33–41.

    Article  PubMed  CAS  Google Scholar 

  9. Surman OS. The ethics of partial-liver donation. N Engl J Med. 2002;346:1038 (comment).

    Google Scholar 

  10. Kanematsu T, Takenaka K, Matsumata T, Furuta T, Sugimachi K, Inokuchi K. Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer. Ann Surg. 1984;199:51–6.

    Article  PubMed  CAS  Google Scholar 

  11. Matsumata T, Kanematsu T, Shirabe K, Sonoda T, Furuta T, Sugimachi K. Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma. Br J Surg. 1990;77:677–80.

    Article  PubMed  CAS  Google Scholar 

  12. Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al. Bile leakage after hepatic resection. Ann Surg. 2001;233:45–50.

    Article  PubMed  CAS  Google Scholar 

  13. Yamashita Y, Shimada M, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, et al. Effects of preoperative steroid administration on surgical stress in hepatic resection: prospective randomized trial. Arch Surg. 2001;136:328–33.

    Article  PubMed  CAS  Google Scholar 

  14. Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188(3):304–9.

    Article  PubMed  CAS  Google Scholar 

  15. Yonemura Y, Taketomi A, Soejima Y, Yoshizumi T, Uchiyama H, Gion T, et al. Validity of preoperative volumetric analysis of congestion volume in living donor liver transplantation using three-dimensional computed tomography. Liver Transplant. 2005;11:1556–62.

    Article  Google Scholar 

  16. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–9.

    Article  PubMed  CAS  Google Scholar 

  17. Taketomi A, Kayashima H, Soejima Y, Yoshizumi T, Uchiyama H, Ikegami T, et al. Donor risk in adult-to-adult living donor liver transplantation: impact of left lobe graft. Transplantation. 2009;87:445–50.

    Article  PubMed  Google Scholar 

  18. Midorikawa Y, Kubota K, Takayama T, Toyoda H, Ijichi M, Torzilli G, et al. A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease. Surgery. 1999;126:484–91.

    Article  PubMed  CAS  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complication: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  20. Paugam-Burtz C, Janny S, Delefosse D, Dahmani S, Dondero F, Mantz J, et al. Prospective validation of the “fifty-fifty” criteria as an early accurate predictor of death after liver resection in intensive unit patients. Ann Surg. 2009;249:124–8.

    Article  PubMed  Google Scholar 

  21. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206.

    Article  PubMed  Google Scholar 

  22. Hiroshige S, Shimada M, Harada N, Shiotani S, Ninomiya M, Minagawa R, et al. Accurate preoperative estimation of liver-graft volumetry using three-dimensional computed tomography. Transplantation. 2003;75:1561–4.

    Article  PubMed  Google Scholar 

  23. Schroeder T, Malago M, Debatin JF, Goyen M, Nadalin S, Ruehm S. All-in-one imaging protocols for the evaluation of potential living liver donors: comparison of magnetic resonance imaging and multidetector computed tomography. Liver Transplant. 2005;11:776–87.

    Article  Google Scholar 

  24. Salvalaggio PR, Baker TB, Koffron AJ, Fryer JP, Clark L, Superina RA, et al. Liver graft volume estimation in 100 living donors: measure twice, cut once. Transplantation. 2005;80:1181–5.

    Article  PubMed  Google Scholar 

  25. Kayashima H, Taketomi A, Yonemura Y, Ijichi H, Harada N, Yoshizumi T, et al. Accuracy of an age-adjusted formula in assessing the graft volume in living donor liver transplantation. Liver Transplant. 2008;14:1366–71.

    Article  Google Scholar 

  26. Fan ST. Problems of hepatectomy in cirrhosis. Hepatogastroenterology. 1998;45(Suppl 3):1288–90.

    PubMed  Google Scholar 

  27. Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM, et al. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg. 2004;239(2):194–201.

    Article  PubMed  Google Scholar 

  28. Chok KS, Ng KK, Poon RT, Yuen WK, Poon RT, Lo CM, et al. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg. 2009;96(1):81–7.

    Article  PubMed  CAS  Google Scholar 

  29. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705.

    Google Scholar 

  30. Kobayashi S, Gotohda N, Nakagohri T, Takahashi S, Konishi M, Kinoshita T. Risk factors of surgical site infection after hepatectomy for liver cancers. World J Surg. 2009;33(2):312–7.

    Article  PubMed  CAS  Google Scholar 

  31. Swoboda SM, Merz C, Kostuik J, Trentler B, Lipsett PA. Does intraoperative blood loss affect antibiotic serum and tissue concentrations? Arch Surg. 1996;131(11):1165–71.

    Article  PubMed  CAS  Google Scholar 

  32. Silversein JH. Physiologic changes associated with aging. In: O’Leary JP, editor. The physiologic basis of surgery. 2nd ed. Philadelphia: Lippincott Wikkiams & Wilkins; 2002. p. 705–11.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shinji Itoh, Ken Shirabe, Akinobu Taketomi, Kazutoyo Morita, Norifumi Harimoto, Eiji Tsujita, Keishi Sugimachi, Yo-ichi Yamashita, Tomonobu Gion & Yoshihiko Maehara

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  1. Shinji Itoh
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  2. Ken Shirabe
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  3. Akinobu Taketomi
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  4. Kazutoyo Morita
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  5. Norifumi Harimoto
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  6. Eiji Tsujita
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  7. Keishi Sugimachi
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  8. Yo-ichi Yamashita
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  9. Tomonobu Gion
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  10. Yoshihiko Maehara
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Correspondence to Shinji Itoh.

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Itoh, S., Shirabe, K., Taketomi, A. et al. Zero mortality in more than 300 hepatic resections: validity of preoperative volumetric analysis. Surg Today 42, 435–440 (2012). https://doi.org/10.1007/s00595-011-0108-2

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  • DOI: https://doi.org/10.1007/s00595-011-0108-2

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