Sharma Deepak, Adhikari Krishna M, Maharjan Narendra, Pradhan Sumita, Bhandari Ramesh S
Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, NPL.
Cureus. 2023 Jan 21;15(1):e34036. doi: 10.7759/cureus.34036. eCollection 2023 Jan.
Background Extended hepatectomy (≥ 5 liver segments resection) may be required to have a complete surgical resection and provide the best chance of cure of hepatobiliary tumors. It is associated with high morbidity and mortality but with good perioperative care, its outcomes can be improved. This study was conducted to evaluate the early outcomes of extended hepatectomy at a university hospital in Nepal. Methods For this study, prospectively collected data from all patients who underwent extended hepatectomy from October 2012 to April 2022 were reviewed and analyzed retrospectively. Demographic data, liver volume augmentation methods used, intraoperative variables, and postoperative complications were analyzed. Results Seventeen patients underwent extended hepatectomy from October 2012 to April 2022. Among them 11 (64.7%) were female and the mean age was 53.9 ±16.3 years (18-72 years). Right extended hepatectomy was the most commonly performed procedure (n = 15, 88.2%), and left extended hepatectomy was performed in the remaining (n = 2, 11.8%). Six patients underwent liver volume augmentation procedures (35.3%) with portal vein embolization (PVE) in three, portal vein ligation (PVL) in one, and partial associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in two patients. Overall complications were 70% with major complications (Clavien Dindo ≥ IIIa) constituting 35.3%. The most common hepatectomy-specific complication was post-hepatectomy liver failure (PHLF) in six cases. The 30-day mortality was 17.6% (three patients). Conclusion Extended hepatectomy can be performed with acceptable major complications and mortality rates in selected patients.
背景 扩大肝切除术（≥5个肝段切除）可能是实现完整手术切除并提供肝胆肿瘤最佳治愈机会所必需的。它与高发病率和死亡率相关，但通过良好的围手术期护理，其结果可以得到改善。本研究旨在评估尼泊尔一家大学医院扩大肝切除术的早期结果。方法 对于本研究，回顾性分析了2012年10月至2022年4月期间所有接受扩大肝切除术患者的前瞻性收集数据。分析了人口统计学数据、所使用的肝脏体积增大方法、术中变量和术后并发症。结果 2012年10月至2022年4月期间，17例患者接受了扩大肝切除术。其中11例（64.7%）为女性，平均年龄为53.9±16.3岁（18 - 72岁）。右半肝扩大切除术是最常施行的手术（n = 15，88.2%），其余2例（11.8%）施行左半肝扩大切除术。6例患者（35.3%）接受了肝脏体积增大手术，其中3例采用门静脉栓塞（PVE），1例采用门静脉结扎（PVL），2例采用分期肝切除术的部分联合肝脏分隔和门静脉结扎（ALPPS）。总体并发症发生率为70%，严重并发症（Clavien - Dindo≥Ⅲa级）占35.3%。最常见的肝切除特异性并发症是肝切除术后肝衰竭（PHLF），共6例。30天死亡率为17.6%（3例患者）。结论 在选定的患者中，扩大肝切除术可以在可接受的严重并发症和死亡率情况下施行。
