H. A. Lillemoe1, R. K. Marcus1, B. J. Kim1, N. Narula1, C. H. Davis1, T. A. Aloia1 1The University of Texas MD Anderson Cancer Center,Department Of Surgical Oncology,Houston, TX, USA
Introduction: As the majority of liver resections have become parenchymal-sparing, revised terminology is proposed to risk-stratify the broad range of procedures often referred to as "partial" or "minor" hepatectomies.
Methods: Consecutive patients from 2015-2017 classified by Brisbane classification as minor hepatectomy were analyzed. Extent of hepatectomy was further defined by the operating surgeon based on the percent of total liver parenchyma removed. Postoperative outcomes were compared based on whether a patient was classified as < or ≥ 30% hepatectomy. Recovery was defined using patient-reported outcomes (PROs) and surgeon-determined readiness to Return to Intended Oncologic Therapy (RIOT). Categorical variables were analyzed using chi-square or Fisher’s exact test and continuous variables were analyzed using the Mann-Whitney U test.
Results: Percent hepatectomy was determined for 81 patients. The median age was 55 years (IQR 46, 63) and 52% of patients were female. The median percent hepatectomy was 15 (IQR 7.5, 20). Procedures included: partial right hepatectomy (21), partial left hepatectomy (20), caudate resection (1), left lateral bisegmentectomy (4), central hepatectomy (5), and multiple partial hepatectomies (30). Table 1 reflects the percent hepatectomy by procedure title. The majority of operations (47%) were performed for resection of colorectal liver metastases. On analysis of partial hepatectomy of < or ≥ 30%, baseline demographics including age, sex, BMI, and ECOG performance status were similar. More procedures in the ≥ 30% group were performed via open surgical approach, with a substantially longer median operative time (264 minutes vs. 195 minutes, p<0.001) and higher median estimated blood loss (200 cc vs. 100 cc, p<0.001). The ≥ 30% hepatectomy group also had a longer length of stay (5 vs. 4 days, p=0.013) and a higher incidence of surgical complications (44% vs. 18%. p=0.033). The ≥ 30% hepatectomy group trended toward longer time to RIOT (median 28 days) compared to the < 30% group (median 21 days, p=0.081). PRO analysis determined that after ≥ 30% hepatectomy, patients were twice as likely to report severe life interference by symptoms (63% vs. 33%, p=0.057).
Conclusion: Within operations classified as "partial" (or "minor") hepatectomy, there are a spectrum of clinical outcomes that can be predicted by classifying cases by the percent of liver resected. Specifically, a cutoff of 30% liver resection may be a clinically relevant risk-stratifier of patients undergoing a partial hepatectomy.
