Skip to main content

Advertisement

SpringerLink
Log in

Differences in Perioperative Outcomes Between Right and Left Hepatic Lobectomy

  • ORIGINAL ARTICLE
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

The safety of hepatic resection is well documented, but outcome studies comparing right and left hepatic lobectomy are sparse, especially in the context of malignancy. This study analyzes the differences in outcomes between right and left hepatic lobectomy in patients with malignant diagnoses. All patients undergoing right and left hepatic lobectomies for malignancy were extracted from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). The data was analyzed to determine differences in perioperative mortality and morbidity between the two groups. A total of 1680 patients who underwent right or left hepatic lobectomy for malignant diagnoses were identified. Patients undergoing right hepatic lobectomy had a four-fold increase in perioperative mortality, compared to left lobectomy (p < 0.0001). Mortality in right lobectomy patients increased incrementally with age, with a 12-fold increase in patients > 81 years of age. Patients undergoing right lobectomy also experienced a statistically significant increase in morbidity involving several systems (infectious, pulmonary, cardiac and renal). The results of our study demonstrate that patients undergoing right hepatic lobectomy for malignancy experience a significantly higher incidence of mortality and multi-system morbidity when compared to left lobectomy. This information will be crucial for pre-operative risk-stratification of patients undergoing hepatic resection for malignancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM (2004) National trends in the use and outcomes of hepatic resection. J Am Coll Surg 199(1):31–38

    Article  PubMed  Google Scholar 

  2. Kim Y, Amini N, He J, Margonis GA, Weiss M, Wolfgang CL et al (2015) National trends in the use of surgery for benign hepatic tumors in the United States. Surgery 157:1055–1064

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fong Y, Salo J (1999) Surgical therapy of hepatic colorectal metastasis. Semin Oncol 26(5):514–523

    CAS  PubMed  Google Scholar 

  4. Gigot JF, Glineur D, Santiago Azagra J, Goergen M, Ceuterick M, Morino M et al (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236(1):90–97

    Article  PubMed  PubMed Central  Google Scholar 

  5. Buell JF, Rosen S, Yoshida A, Labow D, Limsrichamrern S, Cronin DC et al (2000) Hepatic resection: effective treatment for primary and secondary tumors. Surgery 128(4):686–693

    Article  CAS  PubMed  Google Scholar 

  6. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236(4):397–406, discussion-7

    Article  PubMed  PubMed Central  Google Scholar 

  7. Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL et al (1998) Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg Off J Soc Surg Aliment Tract 2(1):11–20

    Article  CAS  Google Scholar 

  8. Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM (2009) The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 208(4):528–538

    Article  PubMed  Google Scholar 

  9. Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. J Am Med Assoc 280(20):1747–1751

    Article  CAS  Google Scholar 

  10. Karanjia ND, Lordan JT, Quiney N, Fawcett WJ, Worthington TR, Remington J (2009) A comparison of right and extended right hepatectomy with all other hepatic resections for colorectal liver metastases: a ten-year study. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 35(1):65–70

    CAS  Google Scholar 

  11. Zeyneloglu P, Pirat A, Balci ST, Torgay A, Cinar O, Sevmis S et al (2008) A comparison of right and left lobectomies for living donor liver transplantation: an anesthesiologist’s point of view. Transplant Proc 40(1):53–56

    Article  CAS  PubMed  Google Scholar 

  12. Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K et al (2003) Operative morbidity of living liver donors in Japan. Lancet 362(9385):687–690

    Article  PubMed  Google Scholar 

  13. Salame E, Goldstein MJ, Kinkhabwala M, Kapur S, Finn R, Lobritto S et al (2002) Analysis of donor risk in living-donor hepatectomy: the impact of resection type on clinical outcome. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg 2(8):780–788

    Article  Google Scholar 

  14. Tzeng CW, Cooper AB, Vauthey JN, Curley SA, Aloia TA (2014) Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB Off J Int Hepato Pancreato Biliary Assoc 16(5):459–468

    Article  Google Scholar 

  15. Nobili C, Marzano E, Oussoultzoglou E, Rosso E, Addeo P, Bachellier P et al (2012) Multivariate analysis of risk factors for pulmonary complications after hepatic resection. Ann Surg 255(3):540–550

    Article  PubMed  Google Scholar 

  16. Tzeng CW, Katz MH, Fleming JB, Pisters PW, Lee JE, Abdalla EK et al (2012) Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications: analysis of 5651 National Surgical Quality Improvement Program patients. HPB Off J Int Hepato Pancreato Biliary Assoc 14(8):506–513

    Article  Google Scholar 

  17. Siu J, McCall J, Connor S (2014) Systematic review of pathophysiological changes following hepatic resection. HPB Off J Int Hepato Pancreato Biliary Assoc 16(5):407–421

    Article  Google Scholar 

  18. Ferrero A, Vigano L, Polastri R, Muratore A, Eminefendic H, Regge D et al (2007) Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg 31(8):1643–1651

    Article  PubMed  Google Scholar 

  19. Dayangac M, Taner CB, Yaprak O, Demirbas T, Balci D, Duran C et al (2011) Utilization of elderly donors in living donor liver transplantation: when more is less? Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 17(5):548–555

    Google Scholar 

  20. Hwang S, Lee SG, Lee YJ, Sung KB, Park KM, Kim KH et al (2006) Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 12(6):920–927

    Google Scholar 

  21. Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877

    Article  PubMed  Google Scholar 

  22. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S et al (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204(5):854–862, discussion 62-4

    Article  PubMed  Google Scholar 

  23. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191(1):38–46

    Article  CAS  PubMed  Google Scholar 

Download references

ACS-NSQIP Disclosure Statement

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, 984030 Nebraska Medical Center, Omaha, NE, 68198-3280, USA

    Jeffrey Douaiher & Chandrakanth Are

  2. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mashaal Dhir

  3. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Lynette Smith

Authors
  1. Jeffrey Douaiher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mashaal Dhir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lynette Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chandrakanth Are
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chandrakanth Are.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Douaiher, J., Dhir, M., Smith, L. et al. Differences in Perioperative Outcomes Between Right and Left Hepatic Lobectomy. Indian J Surg Oncol 7, 44–51 (2016). https://doi.org/10.1007/s13193-015-0464-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-015-0464-2

Keywords

Search

Navigation