No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: Is there a way? A prospective analysis of our approach

Guido Torzilli, Masatoshi Makuuchi, Kazuto Inoue, Tadatoshi Takayama, Yoshihiro Sakamoto, Yasuhiko Sugawara, Keiichi Kubota, Alberto Zucchi

Research output: Contribution to journalArticle

414 Citations (Scopus)

Abstract

Background: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. Hypothesis: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. Design: Prospective validation cohort study. Setting: University hospital. Patients: One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers. Interventions: The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion. Main Outcome Measures: The 30-day postoperative mortality and morbidity rates. Results: All the patients underwent surgery, (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2%, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P = .05). Conclusion: With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs especially in patients with associated liver cirrhosis.

Original languageEnglish
Pages (from-to)984-992
Number of pages9
JournalArchives of Surgery
Volume134
Issue number9
DOIs
Publication statusPublished - 1999

Fingerprint

Hepatocellular Carcinoma
Mortality
Liver
Morbidity
Perioperative Care
Warm Ischemia
Bed Rest
Indocyanine Green
Segmental Mastectomy
Validation Studies
Recovery of Function
Transaminases
Serum
Bilirubin
Ascites
Blood Transfusion
Liver Cirrhosis
Dissection
Ultrasonography
Fibrosis

ASJC Scopus subject areas

  • Surgery

Cite this

No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients : Is there a way? A prospective analysis of our approach. / Torzilli, Guido; Makuuchi, Masatoshi; Inoue, Kazuto; Takayama, Tadatoshi; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Kubota, Keiichi; Zucchi, Alberto.

In: Archives of Surgery, Vol. 134, No. 9, 1999, p. 984-992.

Research output: Contribution to journalArticle

Torzilli, Guido ; Makuuchi, Masatoshi ; Inoue, Kazuto ; Takayama, Tadatoshi ; Sakamoto, Yoshihiro ; Sugawara, Yasuhiko ; Kubota, Keiichi ; Zucchi, Alberto. / No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients : Is there a way? A prospective analysis of our approach. In: Archives of Surgery. 1999 ; Vol. 134, No. 9. pp. 984-992.
@article{54fe0d7002b841b8b2f5a9e67b15679c,
title = "No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: Is there a way? A prospective analysis of our approach",
abstract = "Background: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. Hypothesis: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. Design: Prospective validation cohort study. Setting: University hospital. Patients: One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8{\%}), and only 7 (6.5{\%}) had normal livers. Interventions: The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion. Main Outcome Measures: The 30-day postoperative mortality and morbidity rates. Results: All the patients underwent surgery, (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2{\%}, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P = .05). Conclusion: With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs especially in patients with associated liver cirrhosis.",
author = "Guido Torzilli and Masatoshi Makuuchi and Kazuto Inoue and Tadatoshi Takayama and Yoshihiro Sakamoto and Yasuhiko Sugawara and Keiichi Kubota and Alberto Zucchi",
year = "1999",
doi = "10.1001/archsurg.134.9.984",
language = "English",
volume = "134",
pages = "984--992",
journal = "Archives of Surgery",
issn = "0004-0010",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients

T2 - Is there a way? A prospective analysis of our approach

AU - Torzilli, Guido

AU - Makuuchi, Masatoshi

AU - Inoue, Kazuto

AU - Takayama, Tadatoshi

AU - Sakamoto, Yoshihiro

AU - Sugawara, Yasuhiko

AU - Kubota, Keiichi

AU - Zucchi, Alberto

PY - 1999

Y1 - 1999

N2 - Background: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. Hypothesis: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. Design: Prospective validation cohort study. Setting: University hospital. Patients: One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers. Interventions: The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion. Main Outcome Measures: The 30-day postoperative mortality and morbidity rates. Results: All the patients underwent surgery, (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2%, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P = .05). Conclusion: With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs especially in patients with associated liver cirrhosis.

AB - Background: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. Hypothesis: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. Design: Prospective validation cohort study. Setting: University hospital. Patients: One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers. Interventions: The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion. Main Outcome Measures: The 30-day postoperative mortality and morbidity rates. Results: All the patients underwent surgery, (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2%, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P = .05). Conclusion: With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs especially in patients with associated liver cirrhosis.

UR - http://www.scopus.com/inward/record.url?scp=0032870752&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032870752&partnerID=8YFLogxK

U2 - 10.1001/archsurg.134.9.984

DO - 10.1001/archsurg.134.9.984

M3 - Article

C2 - 10487594

AN - SCOPUS:0032870752

VL - 134

SP - 984

EP - 992

JO - Archives of Surgery

JF - Archives of Surgery

SN - 0004-0010

IS - 9

ER -