SEGMENT-ORIENTED HEPATIC RESECTION IN THE MANAGEMENT OF MALIGNANT NEOPLASMS OF THE LIVER

Background: Improvements in the understanding of intrahepatic anatomy and radiographic technology have facilitated a segment-oriented approa ch to ii-ver resection. This approach involves the resection of isolat ed anatomic segments or sectors of the liver as dictated by the extent of the;intrahepatic pathology. Segment-oriented resection allows maxi mal conservation of normal liver parenchyma while clearing tumor. This report describes the technical features and the results of a prospect ive evaluation of segmental and sectoral resections in the treatment o f malignant hepatic neoplasms. Study Design: Patients with malignant h epatic neoplasms that were treated with a segment-oriented hepatic res ection were identified from a prospective clinical data base. After un dergoing segment-oriented liver resection, the patients were followed at regular intervals. Recurrent disease was the end point of the study . Followup is reported at a median of 12 months. This review outlines the technique of resection, intraoperative events, operating time, blo od loss, and the ability to obtain negative resection margins. Results : During the 5-year period between July 1992 and July 1997, 400 patien ts underwent liver resection for metastatic neoplasms and hepatocellul ar carcinoma (HCC). During this period, 79 patients (20%) were treated with a segment-oriented resection. These patients represent the study group for this report. The overall mortality rate was 2.5%; all posto perative deaths occurred in patients with HCC and cirrhosis. Overall m orbidity was 26%, The median hospital stay was 8 days. Mean transfusio n requirements were 1.0 +/- 0.3 U of packed red blood cells. Patients with HCC showed a greater transfusion requirement than did patients wi thout HCC: 2.7 +/- 1.2 U versus 0.6 +/- 0.2 U (p < 0.05). Of the patie nts without HCC, 17% required transfusion. During the 12-month median followup period, the overall disease recurrence rate was 23%. Disease recurred at the hepatic-resection margin in 2.5% of the patients. Conc lusions: Segmental resection is a safe technique that allows complete resection of liver tumors with preservation of normal liver parenchyma . Segmental resection;is particularly useful for patients with HCC and patients undergoing repeat liver resections or bilobar resections. (J Am Coil Surg 1998;187:471-481. (C) 1998 by the American College of Su rgeons).