Three Hundred and One Consecutive Extended Right Hepatectomies

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dc.contributor.author Kishi, Yoji
dc.contributor.author Abdalla, Eddie
dc.contributor.author Chun, Yun Shin
dc.contributor.author Zorzi, Daria
dc.contributor.author Madoff, David
dc.contributor.author Wallace, Micheal
dc.contributor.author Curley, Steven
dc.contributor.author Vauthey, Jean-Nicolas
dc.date.accessioned 2015-11-17T13:41:17Z
dc.date.available 2015-11-17T13:41:17Z
dc.date.copyright 2009
dc.date.issued 2015-11-17
dc.identifier.issn 0003-4932 en_US
dc.identifier.uri http://hdl.handle.net/10725/2601
dc.description.abstract Objective(s): This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤20%. Background Data: An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%. Methods: The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression. Results: Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥30% but higher in patients with sFLR ≤20% (P < 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤20% (odds ratio = 3.18; 95% CI, 1.34–7.54) independently predicted postoperative liver insufficiency. Conclusions: Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE. en_US
dc.language.iso en en_US
dc.title Three Hundred and One Consecutive Extended Right Hepatectomies en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle Evaluation of Outcome Based on Systematic Liver Volumetry 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 250 en_US
dc.journal.issue 4 en_US
dc.article.pages 540-548 en_US
dc.identifier.doi http://dx.doi.org/10.1097/SLA.0b013e3181b674df en_US
dc.identifier.ctation Kishi, Y., Abdalla, E. K., Chun, Y. S., Zorzi, D., Madoff, D. C., Wallace, M. J., ... & Vauthey, J. N. (2009). Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Annals of surgery, 250(4), 540-548. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://www.jbc.org/content/278/29/26897.short

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