title: Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence.
abstract: OBJECTIVE
  Analyze the characteristics, surgical technique, morbidity and survival of patients treated with extreme liver surgery.
  
  
  METHODS
  We present a series of consecutive patients with malignant liver tumors in hepatocaval confluence treated in a single center with extreme liver surgery (April 2008-March 2015). Data were collected prospectively and analyzed with SPSS 21.0.
  
  
  RESULTS
  12 patients were included. 50 % were male and 50 % were female with a mean age of 59 ± 10 years old. The median of comorbidities was 7 according to the Charlson Age Comorbidity Index. The 75 % of the tumors were metastases, most of them from colorectal cancer. Most of the patients received neoadjuvant chemotherapy and in 58 % preoperative portal embolization was performed. Major hepatectomies were performed (66.7 % extended right hepatectomy, 33.3 % left extended hepatectomy). The 83.3 % of the patients needed vascular reconstruction. Postoperative morbidity was more than grade II in 50 % of the patients according to Dindo-Clavien classification. There was no intraoperative mortality. The postoperative mortality rate at 90 days was 33 % due to hepatic failure and biliary fistula. In December 2015, 33 % of the patients are still alive with a mean survival of 19 months (13-23) with an ECOG Performance Status of 0.
  
  
  CONCLUSIONS
  Extreme liver surgery carries a high rate of morbidity and mortality that seem to increase with age and with higher tumor volumes, according to the literature. It is a therapeutic option to consider in patients with low comorbidity suffering from malignant neoplasms that involve the hepatocaval confluence, when no other treatment with curative intention can be performed.
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain. clcodony@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Codony
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Girona, Girona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: López-Ben
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Girona, Girona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Albiol
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Girona, Girona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Falgueras
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Girona, Girona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Castro
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Codina-Barreras
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Casellas
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gil
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Girona, Girona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Codina-Cazador
authors.affiliation: Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain.|Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Figueras
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Extracorporeal circulation; Hepatectomy; Liver neoplasms