Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK.
Department of General Surgery, Whittington Hospital, London N19 5NF, UK.
Hepatobiliary Pancreat Dis Int. 2022 Apr;21(2):113-133. doi: 10.1016/j.hbpd.2021.12.005. Epub 2021 Dec 16.
Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS).
This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS.
Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS.
With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.
原发性和继发性肝肿瘤因位置和大小的原因并非总是可以进行切除。肝剩余体积不足（FLR）可能会使患者无法进行根治性切除，或者可能导致与小肝综合征（SFSS）相关的术后并发症的发病率和死亡率增加。
这篇综合综述分析了 SFSS 相关的原则、机制和危险因素，并介绍了在规划肝手术时评估 FLR 时目前可用的选择。此外，它详细描述了可以在手术前、手术中和手术后使用的特定方式，以优化安全切除的条件并最大程度地降低 SFSS 的风险。
旨在减少肿瘤负担、保留健康肝实质、诱导 FLR 肥大或预防术后并发症的几种方法有助于降低 SFSS 的风险。
通过这些技术，对肝肿瘤患者进行根治性治疗的适应证已大大扩大。成功的结果取决于适当的患者选择、干预措施的个体化和修改以及手术的正确时机。
