Liver-sparing operation: beneficial approach for liver cancer patients17 Mar 2015
A surgical approach in which a surgeon removes less than a lobe (hemi-liver) of the liver in a patient undergoing an operation for liver cancer is associated with lower mortality and complication rates, according to new study.
Although, the five-year survival rate of selected patients who undergo a complete liver resection is as high as 50%, yet many people aren't operated on because of the high complication rate, blood loss, and liver dysfunction associated with a major hepatectomy.
Details and method the study
The aim of this retrospective study was to investigate the correlation between surgical methods, mortality, and complication rates over the last 19 years. Dr. Kingham and his colleagues at the Memorial Sloan Kettering Cancer Center (MSK) analyzed hospital records of all patients who underwent liver resection for a malignant diagnosis from 1993 to 2012 at their cancer center.
There were 3,875 patients who underwent 4,152 resections for cancer entered into the MSK database. The most common diagnosis was metastatic colorectal cancer. The researchers divided the patients into three equal groups according to time period: early (1993 to 1999), middle (2000 to 2006), and late (2007 to 2012).
They then looked at what percentage of cases in each era were major versus minor hepatectomies and compared outcomes in terms of surgical morbidity and mortality rates between the three time periods.
After analyzing the data, Dr. Kingham and his colleagues found that:
- Over the study period, the 90-day mortality rate decreased from 5% to 1.6%.
- Overall complications dropped from 53% to 20%.
- The percentage of major hepatectomies decreased from 66% to 36%.
- The transfusion rate decreased from 51% to 21% and
- Liver dysfunction for all cases decreased from 3% to 1%.
One interesting finding was that the mortality risk for major hepatectomies remained the same in all three time periods, suggesting that the improved outcomes were related specifically to the increased use of parenchymal sparing resections.
“The more segments of liver that you take out, the higher the risk to the patient”
In addition, the researchers found that abdominal infections were the most common complication of liver surgical procedures. The study authors conclude that encouraging parenchymal preservation (preservation procedure where less than a lobe of the liver is removed without compromising principles of cancer surgery) and preventing abdominal infections are critical for continued improvement of liver procedure outcomes.
"Our study shows that parenchymal preservation should be applied to all patients undergoing liver operations for malignancies because the data show that the mortality rate and complication rate, the blood loss, the requirement for blood transfusions, time in the hospital, all of these things which we are all trying to improve on, are all less," Dr. Kingham said. “While it may be technically easier to remove more liver in some cases, it is worth considering a technically more challenging approach to remove less liver. In the end, there is a real difference in a patient's mortality risk: the more segments of liver that you take out, the higher the risk to the patient." he said.Source: Science Daily