Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence

• C. Codony ^[1] ; S. López-Ben ^[1] ; M. Albiol ^[1] ; L. Falgueras ^[1] ; E. Castro ^[1] ; A. Codina-Barreras ^[1] ; M. Casellas ^[1] ; J. Gil ^[1] ; A. Codina-Cazador ^[1] ; J. Figueras ^[1]
  1. [1] Hospital Doctor Josep Trueta, España
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 18, Nº. 11 (November 2016), 2016, págs. 1131-1139
• Idioma: inglés
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• Resumen

  • Objective Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery.

    Materials and methods 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.

    Results 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.

    Conclusion 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.