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Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort

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Abstract

Purpose

The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis.

Methods

Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed.

Results

The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12–20) and this score was 3 (2–6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity.

Conclusion

The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey

    Selcuk Gulmez, Erdal Polat, Aziz Serkan Senger, Orhan Uzun, Omer Ozduman, Ayhan Oz, Ismail Ege Subasi & Mustafa Duman

  2. Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, SBU, Bursa Yuksek Ihtisas EAH, Mimar Sinan Mahallesi, Emniyet Caddesi, 16310, Yildirim, Bursa, Turkey

    Ugur Duman

Authors
  1. Selcuk Gulmez
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  2. Erdal Polat
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  3. Ugur Duman
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  4. Aziz Serkan Senger
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  5. Orhan Uzun
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  6. Omer Ozduman
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  7. Ayhan Oz
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  8. Ismail Ege Subasi
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  9. Mustafa Duman
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Contributions

Study conception and design: Selcuk Gulmez, Mustafa Duman, Erdal Polat; acquisition of data: Aziz Serkan Senger, Orhan Uzun, Ayhan Oz, Omer Ozduman; analysis and interpretation of data: Ugur Duman, Ismail Ege Subasi, Erdal Polat; drafting of manuscript: Ugur Duman, Selcuk Gulmez, Erdal Polat, Mustafa Duman; critical revision of manuscript: Ugur Duman, Selcuk Gulmez.

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Correspondence to Ugur Duman.

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2020/13/299.

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Gulmez, S., Polat, E., Duman, U. et al. Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort. Langenbecks Arch Surg 407, 1201–1207 (2022). https://doi.org/10.1007/s00423-021-02386-4

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  • DOI: https://doi.org/10.1007/s00423-021-02386-4

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