Is extended hepatectomy for hepatobiliary malignancy justified?

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dc.contributor.author Abdalla, Eddie
dc.contributor.author Vauthey, Nicolas
dc.contributor.author Pawlik, Timothy
dc.contributor.author Arens, James
dc.contributor.author Nemr, Rabih
dc.contributor.author Wei, Steven
dc.contributor.author Kennamer, Debra
dc.contributor.author Ellis, Lee
dc.contributor.author Curley, Steven
dc.date.accessioned 2015-11-11T07:43:37Z
dc.date.available 2015-11-11T07:43:37Z
dc.date.copyright 2004
dc.date.issued 2015-11-11
dc.identifier.issn 0003-4932 en_US
dc.identifier.uri http://hdl.handle.net/10725/2529
dc.description.abstract Background: Extended hepatectomy may be required to provide the best chance for cure of hepatobiliary malignancies. However, the procedure may be associated with significant morbidity and mortality. Methods: We analyzed the outcome of 127 consecutive patients who underwent extended hepatectomy (resection of ≥ 5 liver segments) for hepatobiliary malignancies. Results: The patients underwent extended hepatectomy for colorectal metastases (n = 86; 67.7%), hepatocellular carcinoma (n =12; 9.4%), cholangiocarcinoma (n =14; 11.0%), and other malignant diseases (n =15; 11.5%). Thirty-two left and ninety-five right extended hepatectomies were performed. Eight patients also underwent caudate lobe resection, and 40 patients underwent a synchronous intraabdominal procedure. Twenty patients underwent radiofrequency ablation, and 31 underwent preoperative portal vein embolization. The median blood loss was 300 mL for right hepatectomy and 600 mL for left hepatectomy (P = 0.02). Thirty-six patients (28.3%) received a blood transfusion. The overall complication rate was 30.7% (n = 39), and the operative mortality rate was 0.8% (n = 1). Significant liver insufficiency (total bilirubin level > 10 mg/dL or international normalized ratio > 2) occurred in 6 patients (4.7%). Multivariate analysis showed that a synchronous intraabdominal procedure was the only factor associated with an increased risk of morbidity (hazard ratio [HR], 4.9; P = 0.02). The median survival was 41.9 months. The overall 5-year survival rate was 25.5%. Conclusions: Extended hepatectomy can be performed with a near-zero operative mortality rate and is associated with long-term survival in a subset of patients with malignant hepatobiliary disease. Combining extended hepatectomy with another intraabdominal procedure increases the risk of postoperative morbidity. en_US
dc.language.iso en en_US
dc.title Is extended hepatectomy for hepatobiliary malignancy justified? en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Annals of surgery en_US
dc.journal.volume 239 en_US
dc.journal.issue 5 en_US
dc.article.pages 722–732 en_US
dc.identifier.doi http://dx.doi.org/10.1097/01.sla.0000124385.83887.d5 en_US
dc.identifier.ctation Vauthey, J. N., Pawlik, T. M., Abdalla, E. K., Arens, J. F., Nemr, R. A., Wei, S. H., ... & Curley, S. A. (2004). Is extended hepatectomy for hepatobiliary malignancy justified?. Annals of surgery, 239(5), 722. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://journals.lww.com/annalsofsurgery/Abstract/2004/05000/Is_Extended_Hepatectomy_for_Hepatobiliary.17.aspx

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