This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (2)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Oncology, Other  • Surgical Oncology  • Hepatobiliary Surgery  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic

Implication for Preoperative Portal Vein Embolization

Barbara H. Chik, MBBS; Chi Leung Liu, MS, MD; Sheung Tat Fan, MS, MD, PhD; Chung Mau Lo, MS; Ronnie T. P. Poon, MS; Chi Ming Lam, MS; John Wong, PhD

Arch Surg. 2007;142(1):63-69.

Hypothesis  Major hepatic resection for hepatocellular carcinoma (HCC) is associated with high operative morbidity and mortality, especially in patients with underlying chronic liver disease. The present study evaluated the factors associated with increased operative risks in patients who underwent extended right-sided hepatic resection for HCC.

Design  Retrospective study.

Setting  Tertiary referral center.

Patients  A retrospective study was performed on 172 patients who underwent extended right-sided hepatic resection of more than 4 Couinaud segments for HCC during a 16-year period (January 1, 1989, to December 31, 2004) to evaluate the clinical factors associated with operative morbidity and mortality.

Main Outcome Measure  Risk factors associated with hospital mortality and major operative morbidity.

Results  The overall major morbidity and hospital mortality rates were 14.0% and 8.1%, respectively. On multivariate analysis, small tumor size, conventional-approach hepatectomy, Child-Pugh grade B cirrhosis, and preexisting tumor rupture were the independent factors significantly associated with an increased risk of operative mortality. Discriminant analysis showed that a tumor size smaller than 10 cm significantly increased the risk of operative mortality compared with larger tumors (17.2% vs 3.5%; P = .046).

Conclusions  Anterior approach is the preferred technique for extended right-sided hepatic resection for HCC. Increased risk of operative mortality was identified in patients who had a small tumor, which was associated with the resection of a large volume of functioning liver parenchyma. Preoperative portal vein embolization should be considered in this group of patients to enhance atrophy of the right lobe and hypertrophy of the future liver remnant to minimize the operative risk.

Author Affiliations: Centre for the Study of Liver Disease and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.

RELATED ARTICLE

Tumor Size and Operative Risks of Extended Right-Sided Hepatic Resection for Hepatocellular Carcinoma—Invited Critique
J. Augusto Bastidas
Arch Surg. 2007;142(1):69.
EXTRACT | FULL TEXT