Central hepatectomy versus extended hepatectomy for liver malignancy: a matched cohort comparison.
OBJECTIVE
To compare surgical outcomes between matched central hepatectomy (CH) and extended hepatectomy (EH) groups.


BACKGROUND
Surgical choices for centrally located liver tumours are limited. The traditional EH harbours substantial risks, whereas CH is an alternative parenchymal-sparing resection that may improve peri-operative morbidity.


METHODS
A review of 4661 liver resections at a single institution was performed. The cases (CH) were matched in a 1:1 ratio with EH controls.


RESULTS
The CH group was matched for demographic, tumour and laboratory factors with either right EH or combined (right/left) EH groups (n = 63 per group). Colorectal liver metastases were the most common diagnosis occurring in 70% of the patients. Higher intra-operative blood loss was observed in the right EH(P = 0.01) and combined EH groups (P < 0.01) compared with the CH group. There was a trend towards lower 90-day morbidity in the CH group (43%) compared with the right EH(59%, P = 0.1) and combined EH groups (56%, P = 0.2). The length of hospital stay was significantly longer in the control groups (P < 0.01 for both). The control groups had significantly higher post-operative bilirubin and International Normalized Ratio (INR) levels compared with the CH group. A post-operative bilirubin higher than 4 mg/dl was observed in 2% of the CH group compared with 39% of the right EH group (P < 0.01) and 52% of the combined EH group (P < 0.01). No differences in the rates of bile leak/biloma, post-hepatectomy liver failure or 90-day mortality were found.


CONCLUSIONS
CH, as compared with EH, was safe and associated with a shorter hospital stay and less post-operative liver dysfunction. CH should be considered in patients with centrally located tumours amenable to such a resection.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.
Ser Yee
http://orcid.org/0000-0001-9119-7408
SY
Lee
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eran
E
Sadot
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Joanne F
JF
Chou
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Mithat
M
Gönen
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Thomas Peter
TP
Kingham
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Peter J
PJ
Allen
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ronald P
RP
DeMatteo
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
William R
WR
Jarnagin
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Michael I
MI
D'Angelica
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome