A. M. Attili1,2, I. Sucandy1, N. Patel1, J. Spence1, K. Luberice1, T. Bourdeau1, S. Ross1, A. Rosemurgy1 1Florida Hospital Tampa,General Surgery,Tampa`, FL, USA 2University Of Central Florida,General Surgery,Orlanda, FL, USA
Introduction: Hepatectomy is the gold standard curative treatment for hepatic neoplasms in patients with preserved liver function. Many large tumors involving central liver segments require extended hepatectomy (EH) to gain complete resection with negative margins,however some patients with impaired liver function are offered non surgical options due to high morbidity and mortality following this major operation. Outcome data is relatively limited with the majority of extended hepatectomies offered only at major hepatobiliary centers. We aim to describe outcomes of EH at our hepatobiliary center.
Methods: With institutional review board approval, all patients undergoing hepatectomy between 2012-2017 were prospectively followed. Patient demographic data, perioperative outcomes, and short/long-term survival data were collected and analyzed. Data are presented as median (mean ± SD).
Results: A total of 91 patients underwent hepatectomy (open and robotic approach) within the study period with 10 patients undergoing EH. The majority of patients who underwent EH were women (70%), age of 63 (60.3 ± 16.5) years, body mass index of 24 (24.7 ± 3.8) kg/m2, and MELD score of 11 (10.9 ± 1.6). Six patients underwent an extended right hepatectomy (resecting segment IV-VIII), while 4 patients underwent extended left hepatectomy (resecting segment II-V and VIII). Indications were Klatskin tumor (30%), hepatocellular carcinoma (30%), intrahepatic cholangiocarcinoma (20%), and metastatic neuroendocrine tumor (20%). Operative time was 224 (253.1 ± 111.7) minutes with estimated blood loss of 500 (845 ± 1002.9) ml. No intraoperative complications were seen. One patient had blood transfusion. Negative resection margins (R0) were achieved in 9 patients. One patient with R1 resection margin had hepatocellular carcinoma involving a deep intrahepatic portion of the right hepatic duct, where bile duct resection followed by hepaticojejunostomy was unsafe to perform. Two patients experienced postoperative complications (pleural effusion requiring thoracentesis in one patient and respiratory failure leading to multisystem organ failure and death in another). Length of intensive care unit stay was 2(2.1 ± 1.5) days, and hospital stay was 5(5.6 ± 2.6) days. Readmissions to the hospital were seen in 3 patients (failure to thrive in 2 patients and development of postoperative ascites with pulmonary embolism in 1 patient). 80% of the patients are currently alive with median follow up of 41.2 months.
Conclusion: Despite major concerns of postoperative complications and liver failure for patients with a component of liver dysfunction who has otherwise resectable tumors, EH can be a feasible curative option for these patients. Clinical success mainly depends on preoperative planning, experience of hepatobiliary team, and optimum postoperative care.