Current role of trisectionectomy for hepatopancreatobiliary malignancies
Abstract Background Trisectionectomy is a treatment option in extensive liver malignancy, including colorectal liver metastases (CRLM). However, the reported experience of this procedure is limited. Therefore, we present our experience with right hepatic trisectionectomy (RHT) for CRLM as an example...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12292 |
| _version_ | 1797895632790224896 |
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| author | Philipp Kron Norihisa Kimura Shahid Farid J. Peter A. Lodge |
| author_facet | Philipp Kron Norihisa Kimura Shahid Farid J. Peter A. Lodge |
| author_sort | Philipp Kron |
| collection | DOAJ |
| description | Abstract Background Trisectionectomy is a treatment option in extensive liver malignancy, including colorectal liver metastases (CRLM). However, the reported experience of this procedure is limited. Therefore, we present our experience with right hepatic trisectionectomy (RHT) for CRLM as an example and discuss the changing role of trisectionectomy in the context of modern treatment alternatives based on a literature review. Methods Between January 1993 and December 2014 all patients undergoing RHT at a single center in the UK for CRLM were included. Patient and tumor characteristics were reviewed and a multivariate analysis was done. Based on a literature review the role of trisectionectomy in the treatment of HPB malignancies was discussed. Results A total of 211 patients undergoing RHT were included. Overall perioperative morbidity was 40.3%. Overall 90‐day mortality was 7.6% but reduced to 2.8% over time. Multivariate analysis identified additional organ resection (P = .040) and blood transfusion (P = .028) as independent risk factors for morbidity. Multiple tumors, total hepatic vascular exclusion, and R1 resection were independent risk factors for significantly decreased disease‐free and disease‐specific survival. Further surgery for recurrence after RHT significantly prolonged survival compared with palliative chemotherapy only. Conclusion With the further development of surgical and multimodal treatment strategies in CRLM the indications for trisectionectomy are decreasing. Having being formerly associated with high rates of perioperative morbidity and mortality, this single‐center experience clearly shows that these concomitant risks decrease with experience, liberal use of portal vein embolization and improved patient selection. Trisectionectomy remains relevant in selected patients. |
| first_indexed | 2024-04-10T07:29:57Z |
| format | Article |
| id | doaj.art-93ddb6a5ef5b46a58980a29195c37997 |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-04-10T07:29:57Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-93ddb6a5ef5b46a58980a29195c379972023-02-24T00:30:55ZengWileyAnnals of Gastroenterological Surgery2475-03282019-11-013660661910.1002/ags3.12292Current role of trisectionectomy for hepatopancreatobiliary malignanciesPhilipp Kron0Norihisa Kimura1Shahid Farid2J. Peter A. Lodge3Department of HPB and Transplant Surgery St. James's University Hospital Leeds UKDepartment of HPB and Transplant Surgery St. James's University Hospital Leeds UKDepartment of HPB and Transplant Surgery St. James's University Hospital Leeds UKDepartment of HPB and Transplant Surgery St. James's University Hospital Leeds UKAbstract Background Trisectionectomy is a treatment option in extensive liver malignancy, including colorectal liver metastases (CRLM). However, the reported experience of this procedure is limited. Therefore, we present our experience with right hepatic trisectionectomy (RHT) for CRLM as an example and discuss the changing role of trisectionectomy in the context of modern treatment alternatives based on a literature review. Methods Between January 1993 and December 2014 all patients undergoing RHT at a single center in the UK for CRLM were included. Patient and tumor characteristics were reviewed and a multivariate analysis was done. Based on a literature review the role of trisectionectomy in the treatment of HPB malignancies was discussed. Results A total of 211 patients undergoing RHT were included. Overall perioperative morbidity was 40.3%. Overall 90‐day mortality was 7.6% but reduced to 2.8% over time. Multivariate analysis identified additional organ resection (P = .040) and blood transfusion (P = .028) as independent risk factors for morbidity. Multiple tumors, total hepatic vascular exclusion, and R1 resection were independent risk factors for significantly decreased disease‐free and disease‐specific survival. Further surgery for recurrence after RHT significantly prolonged survival compared with palliative chemotherapy only. Conclusion With the further development of surgical and multimodal treatment strategies in CRLM the indications for trisectionectomy are decreasing. Having being formerly associated with high rates of perioperative morbidity and mortality, this single‐center experience clearly shows that these concomitant risks decrease with experience, liberal use of portal vein embolization and improved patient selection. Trisectionectomy remains relevant in selected patients.https://doi.org/10.1002/ags3.12292colorectal liver metastasesliver resectionright hepatic trisectionectomy |
| spellingShingle | Philipp Kron Norihisa Kimura Shahid Farid J. Peter A. Lodge Current role of trisectionectomy for hepatopancreatobiliary malignancies Annals of Gastroenterological Surgery colorectal liver metastases liver resection right hepatic trisectionectomy |
| title | Current role of trisectionectomy for hepatopancreatobiliary malignancies |
| title_full | Current role of trisectionectomy for hepatopancreatobiliary malignancies |
| title_fullStr | Current role of trisectionectomy for hepatopancreatobiliary malignancies |
| title_full_unstemmed | Current role of trisectionectomy for hepatopancreatobiliary malignancies |
| title_short | Current role of trisectionectomy for hepatopancreatobiliary malignancies |
| title_sort | current role of trisectionectomy for hepatopancreatobiliary malignancies |
| topic | colorectal liver metastases liver resection right hepatic trisectionectomy |
| url | https://doi.org/10.1002/ags3.12292 |
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