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Is extended hepatectomy for hepatobiliary malignancy justified?
Jean-Nicolas Vauthey1, Timothy M Pawlik, Eddie K Abdalla
1Departments of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA. jvauthey@mdanderson.org
Annals of Surgery
|April 15, 2004
Summary
Extended hepatectomy offers a chance for cure in hepatobiliary cancers with low operative mortality. However, combining it with other abdominal procedures increases complication risks.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Extended hepatectomy is crucial for treating hepatobiliary malignancies but carries risks.
- Assessing outcomes of extended hepatectomy is vital for patient management.
Purpose of the Study:
- To analyze the outcomes of extended hepatectomy in patients with hepatobiliary malignancies.
- To identify factors influencing morbidity and mortality after extended hepatectomy.
Main Methods:
- Retrospective analysis of 127 consecutive patients undergoing extended hepatectomy (resection of ≥5 liver segments).
- Data collected included patient demographics, malignancy type, surgical procedures, blood loss, complications, and survival.
- Multivariate analysis was used to identify risk factors for morbidity.
Main Results:
- The most common indications were colorectal metastases (67.7%), cholangiocarcinoma (11.0%), and hepatocellular carcinoma (9.4%).
- Overall complication rate was 30.7%, with operative mortality at 0.8%.
- Synchronous intra-abdominal procedures significantly increased postoperative morbidity (HR, 4.9; P=0.02).
- Median survival was 41.9 months, with a 5-year survival rate of 25.5%.
Conclusions:
- Extended hepatectomy can be performed with low operative mortality for malignant hepatobiliary disease.
- Long-term survival is achievable for a subset of patients.
- Concurrent intra-abdominal procedures elevate the risk of postoperative complications.