Björnsson B, Sparrelid E, Hasselgren K, Gasslander T, Isaksson B, Sandström P
Department of Surgery, Linköping University Hospital, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Scand J Surg. 2016 Sep;105(3):158-62. doi: 10.1177/1457496915613650. Epub 2016 Feb 29.
Associating liver partition and portal vein ligation for staged hepatectomy may increase the possibility of radical resection in the case of liver malignancy. Concerns have been raised about the high morbidity and mortality associated with the procedure, particularly when applied for diagnoses other than colorectal liver metastases. The aim of this study was to analyze the initial experience with associating liver partition and portal vein ligation for staged hepatectomy in cases of non-colorectal liver metastases and primary hepatobiliary malignancies in Scandinavia.
A retrospective analysis of all associating liver partition and portal vein ligation for staged hepatectomy procedures performed at two Swedish university hospitals for non-colorectal liver metastases and primary hepatobiliary malignancies was performed. The primary focus was on the safety of the procedure.
Ten patients were included: four had hepatocellular cancer, three had intrahepatic cholangiocarcinoma, one had a Klatskin tumor, one had ocular melanoma metastasis, and one had a metastasis from a Wilms' tumor. All patients completed both operations, and the highest grade of complication (according to the Clavien-Dindo classification) was 3A, which was observed in one patient. No 90-day mortality was observed. Radical resection (R0) was achieved in nine patients, while the resection was R2 in one patient. The low morbidity and mortality observed in this cohort compared with those of earlier reports on associating liver partition and portal vein ligation for staged hepatectomy for diagnoses other than colorectal liver metastases may be related to the selection of patients with limited comorbidity. In addition, procedures other than associating liver partition and portal vein ligation for staged hepatectomy had been avoided in most of the patients. In conclusion, associating liver partition and portal vein ligation for staged hepatectomy can be applied to primary hepatobiliary malignancies and non-colorectal liver metastases with acceptable rates of morbidity and mortality.
对于肝脏恶性肿瘤患者，联合肝脏分割和门静脉结扎的分期肝切除术可能会增加根治性切除的可能性。人们对该手术相关的高发病率和死亡率表示担忧，尤其是当应用于结直肠癌肝转移以外的诊断时。本研究的目的是分析斯堪的纳维亚半岛非结直肠癌肝转移和原发性肝胆恶性肿瘤患者采用联合肝脏分割和门静脉结扎分期肝切除术的初步经验。
对瑞典两家大学医院为非结直肠癌肝转移和原发性肝胆恶性肿瘤患者实施的所有联合肝脏分割和门静脉结扎分期肝切除术进行回顾性分析。主要关注手术的安全性。
纳入10例患者：4例为肝细胞癌，3例为肝内胆管癌，1例为肝门部胆管癌，1例为眼黑色素瘤转移，1例为肾母细胞瘤转移。所有患者均完成了两次手术，并发症最高等级（根据Clavien-Dindo分类）为3A，1例患者出现该情况。未观察到90天死亡率。9例患者实现了根治性切除（R0），1例患者为R2切除。与早期关于非结直肠癌肝转移以外诊断的联合肝脏分割和门静脉结扎分期肝切除术的报告相比，本队列中观察到的低发病率和死亡率可能与合并症有限的患者选择有关。此外，大多数患者避免了联合肝脏分割和门静脉结扎分期肝切除术以外的手术。总之，联合肝脏分割和门静脉结扎分期肝切除术可应用于原发性肝胆恶性肿瘤和非结直肠癌肝转移，其发病率和死亡率可接受。
