Abstract
Objective
We investigated the risk of morbidity after repeat resections for liver recurrence of hepatocellular carcinoma or for colorectal liver metastases.
Background Data
Although repeat hepatectomy for recurrences of hepatocellular carcinoma or for colorectal cancer liver metastases is well known only to carry risks similar to those seen for an initial liver resection, the safety of such a procedure is questionable because, typically, only a few liver tumors are thought suitable for repeat hepatectomy.
Methods
Clinicopathology data were available for 412 hepatectomy patients (hepatocellular carcinoma in 226, colorectal liver metastases in 186). Risk factors for postoperative complications were analyzed retrospectively among the 57 patients undergoing a repeat hepatectomy.
Results
Using multivariate analysis, intraoperative blood loss (relative risk, 9.61; P = 0.02) affected the occurrence of postoperative complications after a second hepatectomy. In patients who lost more than 1.29 l blood intraoperatively at the second hepatectomy, a major hepatectomy (P < 0.05) by means of an anatomical type of resection (P < 0.01) was more often performed than in the patients with 1.29 l or less of blood loss.
Conclusions
The major independent risk factor associated with complications after a second hepatectomy for liver recurrence was intraoperative blood loss. The extent of liver resection, especially in an anatomical manner, directly influences the amount of blood loss.
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References
Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999; 229:216–222
Shimada M, Takenaka K, Taguchi K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 1998; 227:80–85
Shimada M, Takenaka K, Gion T, et al. Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan. Gastroenterology 1996; 111:720–726
Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003; 238:703–710
Stone MD, Cady B, Jenkins RL, McDermott WV, Steele GD Jr. Surgical therapy for recurrent liver metastases from colorectal cancer. Arch Surg 1990; 125:718–722
Adam R, Bismuth H, Castaing D, et al. Repeat hepatectomy for colorectal liver metastases. Ann Surg 1997; 225:51–62
Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K. Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 1999; 178:275–281
Suzuki S, Sakaguchi T, Yokoi Y, et al. Impact of repeat hepatectomy on recurrent colorectal liver metastases. Surgery 2001; 129:421–428
Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H. Liver resection for colorectal metastases. The third hepatectomy. Ann Surg 2003; 238:871–884
Lise M, Bacchetti S, Da Pian P, Nitti D, Pilati PL, Pigato P. Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998; 82:1028–1036
Chen MF, Hwang TL, Jeng LB, Wang CS, Jan YY, Chen SC. Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years. Arch Surg 1994; 129:738–742
Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991; 214:114–117
Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 2006; 243:229–235
Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999; 229:216–222
Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003; 238:703–710
Ekberg H, Tranberg KG, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S. Pattern of recurrence in liver resection for colorectal secondaries. World J Surg 1987; 11:541–547
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230:309–321
Scheele J, Stangl R, Altendorf-Hofmann A, Gall F. Indications of prognosis after hepatic resection for colorectal secondaries. Surgery 1991; 110:13–29
Wanebo HJ, Chu QD, Avradopoulos KA, Vezeridis MP. Current perspectives on repeat hepatic resection for colorectal carcinoma: a review. Surgery 1996; 119:361–371
Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Moriya Y, Sugihara K. Repeat liver resection for recurrent colorectal liver metastases. Am J Surg 1999; 178:275–281
Yamanaka N, Okamoto E, Oriyama T, et al. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg 1994; 219:342–346
Togo S, Shimada H, Kanemura E, Shizawa R, Endo I, Takahashi T, Tanaka K. Usefulness of three-dimensional computed tomography for anatomic liver resection: sub-subsegmentectomy. Surgery 1998; 123:73–78
Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 2000; 232:777–785
The Brisbane 2000 Terminology of Liver Anatomy and Resection. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2000; 2:333–339
Pringle JH. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908; 48:541–549
Makuuchi M, Mori T, Gunvén P, Yamazaki S, Hasegawa H. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet 1987; 164:155–158
Takasaki K, Kobayashi S, Tanaka S, Muto H, Watayo T. Highly selected hepatic resection by Glissonean sheath-binding method. Dig Surg 1986; 3:121
Tanaka K, Shimada H, Togo S, Takahashi T, Endo I, Sekido H, Yoshida T. Use of transcatheter arterial infusion of anti-cancer agents with lipiodol to prevent recurrence of hepatocellular carcinoma after hepatic resection. Hepato-Gastroenterology 1999; 46:1083–1089
Ichida F, Tsuji T, Omata M, et al. New Inuyama classification for histological assessment of chronic hepatitis. Int Hepatol Commun 1996; 6:112–119
Otsubo T, Takasaki K, Yamamoto M, et al. Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 2004; 135:67–73
Navarra G, Lorenzini C, Curro G, Basaglia E, Habib NH. Early results after radiofrequency-assisted liver resection. Tumori 2004; 90:32–35
Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191:38–46
Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240:698–708; discussion 708–710
Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138:1198–1206
Broering DC, Wilms C, Bok P, et al. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg 2004; 240:1013–1026
Ibrahim S, Chen CL, Lin CC, et al. Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy. Liver Transpl 2006; 12:950–957
Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243:1–7
Parikh AA, Gentner B, Wu TT, Curley SA, Ellis LM, Vauthey JN. Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 2003; 7:1082–1088
Tanaka K, Shimada H, Ueda M, Matsuo K, Endo I, Sekido H, Togo S. Perioperative complications after hepatectomy with or without intra-arterial chemotherapy for bilobar colorectal cancer liver metastases. Surgery 2006; 139:599–607
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Tanaka, K., Shimada, H., Matsuo, K. et al. Intra-operative Blood Loss Predicts Complications After a Second Hepatectomy for Malignant Neoplasms. Ann Surg Oncol 14, 2668–2677 (2007). https://doi.org/10.1245/s10434-007-9427-3
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DOI: https://doi.org/10.1245/s10434-007-9427-3