Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence
Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence
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DOI：
10.1007/s12094-016-1495-z
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发表时间：
2016-11-01
影响因子：
3.4
通讯作者：
Figueras, J.
中科院分区：
文献类型：
--
作者：
Codony, C.;Lopez-Ben, S.;Figueras, J.
分析极端肝手术患者的特点、手术技巧、并发症和生存率。我们报告了一系列在同一个极端肝脏手术中心(2008年4月至2015年3月)治疗的肝下腔静脉汇合部恶性肿瘤患者。前瞻性收集数据，用SPSS21.00.12例患者进行统计分析。50%为男性，50%为女性，平均年龄为59岁+/-10岁。根据Charlson年龄共病指数，合并症的中位数为7。75%的肿瘤是转移性肿瘤，其中大部分来自结直肠癌。大多数患者接受了新辅助化疗，58%的患者术前进行了门静脉栓塞术。行肝大部切除术(右肝扩大切除占66.7%，左肝扩大切除占33.3%)。83.3%的患者需要血管重建。根据Dindo-Clavien分级，50%的患者术后并发症超过II级。无术中死亡。术后90天因肝功能衰竭和胆瘘死亡33%。2015年12月，33%的患者仍然活着，平均生存期为19个月(13-23)，ECOG表现状态为0。根据文献，过度肝手术的发病率和死亡率似乎随着年龄的增长和肿瘤体积的增加而增加。当无法进行其他有治疗意图的治疗时，这是一种治疗方案，可考虑用于低共患率的恶性肿瘤患者，这些患者涉及肝腔融合。
Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery.We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008-March 2015). Data were collected prospectively and analyzed with SPSS 21.0.12 patients were included. 50 % were male and 50 % were female with a mean age of 59 +/- 10 years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75 % of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58 % preoperative portal embolization was performed. Major hepatectomies were performed (66.7 % extended right hepatectomy, 33.3 % left extended hepatectomy). The 83.3 % of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50 % of the patients according to Dindo-Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90 days was 33 % due to hepatic failure and biliary fistula. In December 2015, 33 % of the patients are still alive with a mean survival of 19 months (13-23) with an ECOG Performance Status of 0.Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.