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Portal triad clamping (TC) or hepatic vascular exclusion (VE) for major liver resection after prolonged neoadjuvant chemotherapy? A case-matched study in 60 patients.
- Source :
-
Surgery [Surgery] 2006 Sep; Vol. 140 (3), pp. 396-403. Date of Electronic Publication: 2006 Jul 27. - Publication Year :
- 2006
-
Abstract
- Background: Prolonged systemic preoperative chemotherapy induces pathologic changes in liver parenchyma. The consequences of vascular occlusion on liver submitted to prolonged preoperative systemic chemotherapy are not known. The aim of this case-matched study was to assess which method of vascular occlusion is most appropriate for major liver resection in patients who have undergone prolonged preoperative systemic chemotherapy.<br />Methods: Among 305 patients who had liver resection for colorectal metastases from 1998 to 2003, 28 underwent major liver resections under portal triad clamping after more than 6 cycles of preoperative chemotherapy (TC group). These 28 patients were compared with 32 patients matched for age, sex, ASA status, number of liver metastases, type of liver resection, and type of preoperative chemotherapy, but who had major liver resection under hepatic vascular exclusion after more than 6 cycles of preoperative chemotherapy (VE group).<br />Results: There was no postoperative mortality. The morbidity rate was 18% after TC and 43% after VE (P = 0.044). Pulmonary complication rate was greater after VE (31% vs 3%, P = 0.017). The transfusion rate was 50% in the TC group and 40% in the VE group (P = 0.482). Postoperative changes of liver function tests were comparable in the two groups except for the prothrombin time, which was more prolonged from day 1 (P = 0.003) to day 5 (P = 0.04) after VE.<br />Conclusion: Vascular occlusion can be used with no mortality and acceptable morbidity for major liver resection after prolonged preoperative chemotherapy. TC should be preferred to VE, permitted by the location of the neoplasm.
- Subjects :
- Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols adverse effects
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Colorectal Neoplasms drug therapy
Colorectal Neoplasms pathology
Combined Modality Therapy
Constriction
Embolization, Therapeutic methods
Female
Hepatectomy instrumentation
Humans
Liver blood supply
Liver pathology
Liver surgery
Liver Neoplasms drug therapy
Liver Neoplasms secondary
Male
Middle Aged
Retrospective Studies
Survival Analysis
Treatment Outcome
Vascular Surgical Procedures instrumentation
Hepatectomy methods
Liver drug effects
Liver Neoplasms blood supply
Liver Neoplasms surgery
Neoadjuvant Therapy methods
Portal System surgery
Vascular Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 0039-6060
- Volume :
- 140
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 16934601
- Full Text :
- https://doi.org/10.1016/j.surg.2006.03.023