title: Liver surgery in the era of tissue-preserving resections: early and late outcome in patients with primary and secondary hepatic tumors.
abstract: During recent decades, the understanding of the segmental-oriented liver anatomy has enabled development of resection of isolated liver segments or sectors as dictated by the localization and extent of the mass lesion. These newer surgical procedures provide the advantage of maximal preservation of functional parenchyma, therefore minimizing the occurrence of postoperative liver failure and, at the same time, expanding the indications for surgery. We analyzed the results after classical hemihepatectomies and segment-based resections in a consecutive, nonselected patient group. During the 7-year period between November 1993 and November 2000, 270 patients with primary or secondary liver tumors were treated in our hospital; 167 of these patients underwent curative resections and their relevant data were entered into a statistical database. There were 77 classical hemihepatectomies and 90 tissue-preserving resections. Total mortality and morbidity for the series was 3.6% and 29.9%, respectively. Morbidity but not mortality was significantly lower after tissue-preserving resections than after classical hemihepatectomy. Median follow-up was 36 months. Survival was comparable for the two different surgical approaches for patients with secondary liver malignancies. In contrast, patients with hepatocellular carcinomas lived significantly longer after tissue-preserving resections. Tissue-preserving liver resection is a safe technique allowing maximal preservation of functional parenchyma without compromising radicality. Therefore, tissue-preserving resection is especially useful for patients with hepatocellular carcinomas and cirrhosis.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, CH-3010 Bern, Switzerland. claudio.redaelli@insel.ch
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Redaelli
authors.forename: Markus
authors.initials: M
authors.lastname: Wagner
authors.forename: Lukas
authors.initials: L
authors.lastname: Krähenbühl
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016019:Survival Analysis; D016896:Treatment Outcome