Perioperative management of primary liver cancer.
OBJECTIVE
To minimize the complications and mortality and improve the survival in primary liver cancer (PLC) patients undergoing hepatic resection.


METHODS
We conducted a retrospective analysis of 2143 PLC patients treated from January 1990 to January 2004. The patients were divided into two groups using January 1997 as a cut-off. Small tumor size (< 5 cm), preoperative redox tolerance index (RTI), vascular control method, and postoperative arterial ketone body ratio (AKBR) were used as indicators of surgical outcome.


RESULTS
Small tumors had less complications and lower mortality and higher overall survival rate. Use of RTI for selecting patients and types of hepatectomy, reduced complications (21.1% vs 11.0%) and mortality (1.6% vs 0.3%). The half liver vascular occlusion protocol (n = 523) versus the Pringle method (n = 476) showed that the former significantly reduced the postoperative complications (25.8% vs 11.9%) and mortality (2.3% vs 0.6%) respectively, and cut mean hospital stay was 3.5 d. Postoperative AKBR was a reliable indicator of the energy status in survivors.


CONCLUSIONS
RTI is of value in predicting hepatic functional reserve, half liver occlusion could protect the residual liver function, and AKBR measurement is a simple and accurate means of assessing the state of postoperative metabolism. Optimal perioperative management is an important factor for minimizing complications and mortality in patients undergoing hepatic resection.
Yan
Lu-Nan
LN
Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunan688@163.com
Chen
Xiao-Li
XL
Li
Zhi-Hui
ZH
Li
Bo
B
Lu
Shi-Chun
SC
Wen
Tian-Fu
TF
Zeng
Yong
Y
Yiao
Hui-Hua
HH
Yang
Jia-Yin
JY
Wang
Wen-Tao
WT
Xu
Ming-Qing
MQ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D018281:Cholangiocarcinoma / Q000503:physiopathology / Q000601:surgery*; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000097:blood; D008099:Liver / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D007657:Ketone Bodies