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Improved Early Results of Elective Hepatic Resection for Liver Tumors: One Hundred Consecutive Hepatectomies in Cirrhotic and Noncirrhotic Patients

Improved Early Results of Elective Hepatic Resection for Liver Tumors: One Hundred Consecutive... Abstract • Liver resection for a neoplasm was performed in 100 patients between 1979 and 1987. There were 43 hepatocellular carcinomas (70% of them arising in patients with cirrhosis), 28 metastases from colorectal cancers, 20 benign tumors, and 9 miscellaneous tumors. Forty-nine patients had a major liver resection, 36 a segmentectomy, and 15 a nonanatomic liver resection. Great care was taken to avoid intraoperative and postoperative bleeding, including late ligation of the hepatic vein, the use of Kelly fracture and resorbable clips for hemostasis of transection planes in 74 patients, and temporary clamping of the portal pedicle in 22. Drainage of the abdomen was avoided in 21 patients to prevent ascitic leakage to decrease the postoperative hospital stay. Operative mortality was 1%. There were eight major complications, including one bile leak, one subphrenic abscess, and three subphrenic hematomas. The use of resorbable clips significantly reduced operative time and transfusion requirements. In patients with cirrhosis, temporary clamping of the hepatic pedicle significantly decreased blood loss. Avoiding drainage significantly decreased the postoperative hospital stay. (Arch Surg. 1989;124:1033-1037) References 1. Fortner JG, Kim OK, Maclean BJ, et al. Major hepatic resection for neoplasia: personal experience in 108 patients . Ann Surg . 1978;188:363-371.Crossref 2. Hanks JB, Meyers WC, Filston HC, et al. Surgical resection for benign and malignant liver disease . Ann Surg . 1980;191:584-591.Crossref 3. Adson MA, Weiland LH. Resection of primary solid hepatic tumors . Am J Surg . 1981;141:18-21.Crossref 4. Morrow CE, Grage TB, Sutherland DER, et al. Hepatic resection for secondary neoplasms . Surgery . 1982;92:610-614. 5. Muhe E, Gall FP, Angermann B. Resection of liver metastases . World J Surg . 1982;6:210-215.Crossref 6. Iwatsuki S, Shaw BM, Starzl TE. Experience with 150 liver resections . Ann Surg . 1983;197:247-253.Crossref 7. Thompson HH, Tompkins RK, Longmire WP. Major hepatic resection: a 25-year experience . Ann Surg . 1983;197:375-387.Crossref 8. Adson MA, Van Heerden JA, Adson MH, et al. Resection of hepatic metastases from colorectal cancer . Arch Surg . 1984;119:647-651.Crossref 9. Fortner JG, Silva JS, Golbey RB, et al. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer, I: treatment by hepatic resection . Ann Surg . 1984;199:306-316.Crossref 10. Lim RC, Bongard FS. Hepatocellular carcinoma: changing concepts in diagnosis and management . Arch Surg . 1984;119:637-642.Crossref 11. August DA, Sugarbaker PH, Ottow RT, et al. Hepatic resection of colorectal metastases: influence of clinical factors and adjuvant intraperitoneal 5-fluorouracil via Tenkchoff catheter on survival . Ann Surg . 1985;201:210-218.Crossref 12. Coppa GF, Eng K, Ranson JHC, et al. Hepatic resection for metastatic colon and rectal cancer: an evaluation of preoperative and postoperative factors . Ann Surg . 1985;202:203-208.Crossref 13. Nagao T, Inoue S, Mizuta T, et al. One hundred hepatic resections: indications and operative results . Ann Surg . 1985;202:42-49.Crossref 14. Butler J, Attiyeh FF, Dally JM. Hepatic resection for metastases of the colon and rectum . Surg Gynecol Obstet . 1986;162:109-113. 15. Ekberg H, Tranberg KG, Anderson R, et al. Determinants of survival in liver resection for colorectal secondaries . Br J Surg . 1986;73:727-731.Crossref 16. Lee CS, Sung JL, Hwang LY, et al. Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma . Surgery . 1986;99:481-490. 17. Andrus CH, Kaminsky DL. Segmental hepatic resection utilizing the ultrasonic dissector . Arch Surg . 1986;121:515-521.Crossref 18. Yanaga K, Kanematsu T, Sugimachi K, et al. Intraperitoneal septic complications after hepatectomy . Ann Surg . 1986;203:148-152.Crossref 19. Bradpiece HA, Benjamin IS, Halevy A, et al. Major hepatic resection for colorectal liver metastases . Br J Surg . 1987;74:324-326.Crossref 20. Lin TY, Lee CS, Chen KM, et al. Role of surgery in the treatment of primary carcinoma of the liver: a 31-year experience . Br J Surg . 1987;74:839-842.Crossref 21. Nagasue N, Yukaya H, Chang YC, et al. Appraisal of hepatic resection in the treatment of minute hepatocellular carcinoma associated with liver cirrhosis . Br J Surg . 1987;74:836-838.Crossref 22. Nordlinger B, Quilichini MA, Parc R, et al. Hepatic resection for colorectal liver metastases: influence on survival of preoperative factors and surgery for recurrences in 80 patients . Ann Surg . 1987;205:256-263.Crossref 23. Stimpson REJ, Pellegrini CA, Way LW. Factors affecting the morbidity of elective liver resection . Am J Surg . 1987;153:189-196.Crossref 24. Iwatsuki S, Starzl TE. Experience in 400 hepatic resections . Ann Surg . 1988;208:421-434.Crossref 25. Couinaud C. Le foie: Etudes anatomiques et chirurgicales . New York, NY: Masson Publishers USA Inc; 1975. 26. Franco D, Smadja C, Kahwaji F, et al. Segmentectomies in the management of liver tumors . Arch Surg . 1988;123:519-522.Crossref 27. Lin TY. A most simplified technique for hepatic resection: crush method . Ann Surg . 1974;180:285-290.Crossref 28. Iwatsuki S, Geis WP. Specific complications in surgery of the liver . Surg Clin North Am . 1977;57:409-419. 29. Lortat-Jacob JL, Aubert HG, Henry C. Un cas d'hépatectomie droite réglée . Mem Acad Chir . 1952;78:244-251. 30. Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy . Surg Gynecol Obstet . 1978;147:689-693. 31. Makuuchi M, Hasegawa H. Yamazaki S. Ultrasonically guided subsegmentectomy . Surg Gynecol Obstet . 1985;162:346-350. 32. Castaing D, Emond J, Kunstlinger F, et al. Utility of operative ultrasound in the surgical management of liver tumors . Ann Surg . 1986;204:600-605.Crossref 33. Foster JH. Automatic clip applier as an aid to liver resection . Am J Surg . 1986;151:289-290.Crossref 34. Huguet C, Nordlinger B, Galopin JJ, et al. Tolerance of human liver to prolonged normothermic ischemia: biological study of 20 patients submitted to extensive hepatectomy . Arch Surg . 1978;113:1448-1451.Crossref 35. Nagasue N, Yukaya H, Ogawa Y. Segmental and subsegmental resections on the cirrhotic liver under hepatic inflow and outflow occlusion . Br J Surg . 1985;72:565-568.Crossref 36. Smadja C, Kahwaji F, Berthoux L, et al. Intérêt du clampage pédiculaire total dans les exérèses hépatiques pour carcinome hépatocellulaire chez le cirrhotique . Ann Chir . 1987;41:639-642. 37. Stone HH. Preoperative and postoperative care . Surg Clin North Am . 1977;57:409-419. 38. Gillmore D, McSwain NE, Browder IW. Hepatic trauma: to drain or not to drain? J Trauma . 1987;27:898-902.Crossref 39. Smadja C, Berthoux L, Meakins JL, et al. Pattern of improvement in resection of hepatocellular carcinoma in cirrhotic patients: results of a non drainage policy. HPB Surgery. In press. 40. Stone HH, Long WD, Smith RB, et al. Physiologic consideration in major hepatic resections . Am J Surg . 1969;117:78-84.Crossref 41. Haley RW, Culver DH, Morgan WM, et al. Identifying patients at high risk of surgical wound infection . Am J Epidemiol . 1985;121:206-216. 42. Meakins JL. Guidelines for prevention of wound infection . In: Wilmore DD, Brennan M, Harken A, Holroft J, Meakins JL, eds. The Care of the Surgical Patient . New York, NY: Scientific American Library; 1989;2:chap 5. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Improved Early Results of Elective Hepatic Resection for Liver Tumors: One Hundred Consecutive Hepatectomies in Cirrhotic and Noncirrhotic Patients

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References (46)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410090039008
Publisher site
See Article on Publisher Site

Abstract

Abstract • Liver resection for a neoplasm was performed in 100 patients between 1979 and 1987. There were 43 hepatocellular carcinomas (70% of them arising in patients with cirrhosis), 28 metastases from colorectal cancers, 20 benign tumors, and 9 miscellaneous tumors. Forty-nine patients had a major liver resection, 36 a segmentectomy, and 15 a nonanatomic liver resection. Great care was taken to avoid intraoperative and postoperative bleeding, including late ligation of the hepatic vein, the use of Kelly fracture and resorbable clips for hemostasis of transection planes in 74 patients, and temporary clamping of the portal pedicle in 22. Drainage of the abdomen was avoided in 21 patients to prevent ascitic leakage to decrease the postoperative hospital stay. Operative mortality was 1%. There were eight major complications, including one bile leak, one subphrenic abscess, and three subphrenic hematomas. The use of resorbable clips significantly reduced operative time and transfusion requirements. In patients with cirrhosis, temporary clamping of the hepatic pedicle significantly decreased blood loss. Avoiding drainage significantly decreased the postoperative hospital stay. (Arch Surg. 1989;124:1033-1037) References 1. Fortner JG, Kim OK, Maclean BJ, et al. Major hepatic resection for neoplasia: personal experience in 108 patients . Ann Surg . 1978;188:363-371.Crossref 2. Hanks JB, Meyers WC, Filston HC, et al. Surgical resection for benign and malignant liver disease . Ann Surg . 1980;191:584-591.Crossref 3. Adson MA, Weiland LH. Resection of primary solid hepatic tumors . Am J Surg . 1981;141:18-21.Crossref 4. Morrow CE, Grage TB, Sutherland DER, et al. Hepatic resection for secondary neoplasms . Surgery . 1982;92:610-614. 5. Muhe E, Gall FP, Angermann B. Resection of liver metastases . World J Surg . 1982;6:210-215.Crossref 6. Iwatsuki S, Shaw BM, Starzl TE. Experience with 150 liver resections . Ann Surg . 1983;197:247-253.Crossref 7. Thompson HH, Tompkins RK, Longmire WP. Major hepatic resection: a 25-year experience . Ann Surg . 1983;197:375-387.Crossref 8. Adson MA, Van Heerden JA, Adson MH, et al. Resection of hepatic metastases from colorectal cancer . Arch Surg . 1984;119:647-651.Crossref 9. Fortner JG, Silva JS, Golbey RB, et al. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer, I: treatment by hepatic resection . Ann Surg . 1984;199:306-316.Crossref 10. Lim RC, Bongard FS. Hepatocellular carcinoma: changing concepts in diagnosis and management . Arch Surg . 1984;119:637-642.Crossref 11. August DA, Sugarbaker PH, Ottow RT, et al. Hepatic resection of colorectal metastases: influence of clinical factors and adjuvant intraperitoneal 5-fluorouracil via Tenkchoff catheter on survival . Ann Surg . 1985;201:210-218.Crossref 12. Coppa GF, Eng K, Ranson JHC, et al. Hepatic resection for metastatic colon and rectal cancer: an evaluation of preoperative and postoperative factors . Ann Surg . 1985;202:203-208.Crossref 13. Nagao T, Inoue S, Mizuta T, et al. One hundred hepatic resections: indications and operative results . Ann Surg . 1985;202:42-49.Crossref 14. Butler J, Attiyeh FF, Dally JM. Hepatic resection for metastases of the colon and rectum . Surg Gynecol Obstet . 1986;162:109-113. 15. Ekberg H, Tranberg KG, Anderson R, et al. Determinants of survival in liver resection for colorectal secondaries . Br J Surg . 1986;73:727-731.Crossref 16. Lee CS, Sung JL, Hwang LY, et al. Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma . Surgery . 1986;99:481-490. 17. Andrus CH, Kaminsky DL. Segmental hepatic resection utilizing the ultrasonic dissector . Arch Surg . 1986;121:515-521.Crossref 18. Yanaga K, Kanematsu T, Sugimachi K, et al. Intraperitoneal septic complications after hepatectomy . Ann Surg . 1986;203:148-152.Crossref 19. Bradpiece HA, Benjamin IS, Halevy A, et al. Major hepatic resection for colorectal liver metastases . Br J Surg . 1987;74:324-326.Crossref 20. Lin TY, Lee CS, Chen KM, et al. Role of surgery in the treatment of primary carcinoma of the liver: a 31-year experience . Br J Surg . 1987;74:839-842.Crossref 21. Nagasue N, Yukaya H, Chang YC, et al. Appraisal of hepatic resection in the treatment of minute hepatocellular carcinoma associated with liver cirrhosis . Br J Surg . 1987;74:836-838.Crossref 22. Nordlinger B, Quilichini MA, Parc R, et al. Hepatic resection for colorectal liver metastases: influence on survival of preoperative factors and surgery for recurrences in 80 patients . Ann Surg . 1987;205:256-263.Crossref 23. Stimpson REJ, Pellegrini CA, Way LW. Factors affecting the morbidity of elective liver resection . Am J Surg . 1987;153:189-196.Crossref 24. Iwatsuki S, Starzl TE. Experience in 400 hepatic resections . Ann Surg . 1988;208:421-434.Crossref 25. Couinaud C. Le foie: Etudes anatomiques et chirurgicales . New York, NY: Masson Publishers USA Inc; 1975. 26. Franco D, Smadja C, Kahwaji F, et al. Segmentectomies in the management of liver tumors . Arch Surg . 1988;123:519-522.Crossref 27. Lin TY. A most simplified technique for hepatic resection: crush method . Ann Surg . 1974;180:285-290.Crossref 28. Iwatsuki S, Geis WP. Specific complications in surgery of the liver . Surg Clin North Am . 1977;57:409-419. 29. Lortat-Jacob JL, Aubert HG, Henry C. Un cas d'hépatectomie droite réglée . Mem Acad Chir . 1952;78:244-251. 30. Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy . Surg Gynecol Obstet . 1978;147:689-693. 31. Makuuchi M, Hasegawa H. Yamazaki S. Ultrasonically guided subsegmentectomy . Surg Gynecol Obstet . 1985;162:346-350. 32. Castaing D, Emond J, Kunstlinger F, et al. Utility of operative ultrasound in the surgical management of liver tumors . Ann Surg . 1986;204:600-605.Crossref 33. Foster JH. Automatic clip applier as an aid to liver resection . Am J Surg . 1986;151:289-290.Crossref 34. Huguet C, Nordlinger B, Galopin JJ, et al. Tolerance of human liver to prolonged normothermic ischemia: biological study of 20 patients submitted to extensive hepatectomy . Arch Surg . 1978;113:1448-1451.Crossref 35. Nagasue N, Yukaya H, Ogawa Y. Segmental and subsegmental resections on the cirrhotic liver under hepatic inflow and outflow occlusion . Br J Surg . 1985;72:565-568.Crossref 36. Smadja C, Kahwaji F, Berthoux L, et al. Intérêt du clampage pédiculaire total dans les exérèses hépatiques pour carcinome hépatocellulaire chez le cirrhotique . Ann Chir . 1987;41:639-642. 37. Stone HH. Preoperative and postoperative care . Surg Clin North Am . 1977;57:409-419. 38. Gillmore D, McSwain NE, Browder IW. Hepatic trauma: to drain or not to drain? J Trauma . 1987;27:898-902.Crossref 39. Smadja C, Berthoux L, Meakins JL, et al. Pattern of improvement in resection of hepatocellular carcinoma in cirrhotic patients: results of a non drainage policy. HPB Surgery. In press. 40. Stone HH, Long WD, Smith RB, et al. Physiologic consideration in major hepatic resections . Am J Surg . 1969;117:78-84.Crossref 41. Haley RW, Culver DH, Morgan WM, et al. Identifying patients at high risk of surgical wound infection . Am J Epidemiol . 1985;121:206-216. 42. Meakins JL. Guidelines for prevention of wound infection . In: Wilmore DD, Brennan M, Harken A, Holroft J, Meakins JL, eds. The Care of the Surgical Patient . New York, NY: Scientific American Library; 1989;2:chap 5.

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1989

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