Three Hundred and One Consecutive Extended Right Hepatectomies
Objective(s): This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic rese...
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| المؤلف الرئيسي: | |
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| مؤلفون آخرون: | , , , , , , |
| التنسيق: | article |
| منشور في: |
2009
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| الوصول للمادة أونلاين: | http://hdl.handle.net/10725/2601 http://dx.doi.org/10.1097/SLA.0b013e3181b674df http://www.jbc.org/content/278/29/26897.short |
| الوسوم: |
إضافة وسم
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| _version_ | 1864513458698977280 |
|---|---|
| author | Kishi, Yoji |
| author2 | Abdalla, Eddie Chun, Yun Shin Zorzi, Daria Madoff, David Wallace, Micheal Curley, Steven Vauthey, Jean-Nicolas |
| author2_role | author author author author author author author |
| author_facet | Kishi, Yoji Abdalla, Eddie Chun, Yun Shin Zorzi, Daria Madoff, David Wallace, Micheal Curley, Steven Vauthey, Jean-Nicolas |
| author_role | author |
| dc.creator.none.fl_str_mv | Kishi, Yoji Abdalla, Eddie Chun, Yun Shin Zorzi, Daria Madoff, David Wallace, Micheal Curley, Steven Vauthey, Jean-Nicolas |
| dc.date.none.fl_str_mv | 2009 2015-11-17T13:41:17Z 2015-11-17T13:41:17Z 2015-11-17 |
| dc.identifier.none.fl_str_mv | 0003-4932 http://hdl.handle.net/10725/2601 http://dx.doi.org/10.1097/SLA.0b013e3181b674df Kishi, Y., Abdalla, E. K., Chun, Y. S., Zorzi, D., Madoff, D. C., Wallace, M. J., ... & Vauthey, J. N. (2009). Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Annals of surgery, 250(4), 540-548. http://www.jbc.org/content/278/29/26897.short |
| dc.language.none.fl_str_mv | en |
| dc.relation.none.fl_str_mv | Annals of surgery |
| dc.rights.*.fl_str_mv | info:eu-repo/semantics/openAccess |
| dc.title.none.fl_str_mv | Three Hundred and One Consecutive Extended Right Hepatectomies Evaluation of Outcome Based on Systematic Liver Volumetry |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | Objective(s): This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤20%. Background Data: An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%. Methods: The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression. Results: Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥30% but higher in patients with sFLR ≤20% (P < 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤20% (odds ratio = 3.18; 95% CI, 1.34–7.54) independently predicted postoperative liver insufficiency. Conclusions: Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | LAURepo_b9afafab876c389d64fb35f865232b46 |
| identifier_str_mv | 0003-4932 Kishi, Y., Abdalla, E. K., Chun, Y. S., Zorzi, D., Madoff, D. C., Wallace, M. J., ... & Vauthey, J. N. (2009). Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Annals of surgery, 250(4), 540-548. |
| language_invalid_str_mv | en |
| network_acronym_str | LAURepo |
| network_name_str | Lebanese American University repository |
| oai_identifier_str | oai:laur.lau.edu.lb:10725/2601 |
| publishDate | 2009 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| spelling | Three Hundred and One Consecutive Extended Right HepatectomiesEvaluation of Outcome Based on Systematic Liver VolumetryKishi, YojiAbdalla, EddieChun, Yun ShinZorzi, DariaMadoff, DavidWallace, MichealCurley, StevenVauthey, Jean-NicolasObjective(s): This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤20%. Background Data: An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%. Methods: The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression. Results: Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥30% but higher in patients with sFLR ≤20% (P < 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤20% (odds ratio = 3.18; 95% CI, 1.34–7.54) independently predicted postoperative liver insufficiency. Conclusions: Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.PublishedN/A2015-11-17T13:41:17Z2015-11-17T13:41:17Z20092015-11-17Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article0003-4932http://hdl.handle.net/10725/2601http://dx.doi.org/10.1097/SLA.0b013e3181b674dfKishi, Y., Abdalla, E. K., Chun, Y. S., Zorzi, D., Madoff, D. C., Wallace, M. J., ... & Vauthey, J. N. (2009). Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Annals of surgery, 250(4), 540-548.http://www.jbc.org/content/278/29/26897.shortenAnnals of surgeryinfo:eu-repo/semantics/openAccessoai:laur.lau.edu.lb:10725/26012016-08-26T08:30:48Z |
| spellingShingle | Three Hundred and One Consecutive Extended Right Hepatectomies Kishi, Yoji |
| status_str | publishedVersion |
| title | Three Hundred and One Consecutive Extended Right Hepatectomies |
| title_full | Three Hundred and One Consecutive Extended Right Hepatectomies |
| title_fullStr | Three Hundred and One Consecutive Extended Right Hepatectomies |
| title_full_unstemmed | Three Hundred and One Consecutive Extended Right Hepatectomies |
| title_short | Three Hundred and One Consecutive Extended Right Hepatectomies |
| title_sort | Three Hundred and One Consecutive Extended Right Hepatectomies |
| url | http://hdl.handle.net/10725/2601 http://dx.doi.org/10.1097/SLA.0b013e3181b674df http://www.jbc.org/content/278/29/26897.short |