Aggressive Approaches Improve Liver Surgery Outcomes

A new study has found that patients with liver cancer who have no other treatment options might benefit from more advanced techniques of liver surgery, once considered too aggressive.

Researchers from the University of Florida (UF, Gainsville, USA) reviewed 830 adult patients who underwent hepatectomy between 1997 and 2007. Patients were categorized as having unresectable disease if the disease could not be excised without resection of the inferior vena cava (IVC), hepatic vasculature, or due to tumor extent.

The results showed that despite being so categorized, 116 of the patients initially believed to have unresectable disease went on to laparotomy; of these, 18 patients were found to be unresectable during the operation, but 98 patients were eventually resected: 78 underwent trisectionectomies; 18 had lobectomies; one underwent mesohepatectomy; and one had a segment 5, 6 resection combined with pancreaticoduodenectomy, nephrectomy, and colectomy. Fourteen patients also had pancreatic resections. Vascular reconstructions were performed on the IVC, hepatic veins, portal vein, and hepatic artery. Hypothermic perfusion of the liver was used in 12 patients. Patients undergoing resection had a 6% mortality rate with a morbidity of 35%. Median survival was 37 months and five-year actuarial survival was 32%. The study was published in the June 2008 edition of the Journal of the American College of Surgeons.

"We are doing things that are very complex that could not be done a few years ago and yet getting the same success rates that standard, less complex liver surgery was getting 10 years ago,” said lead author Alan Hemming, M.D., chief of transplantation and hepatobiliary surgery at UF. "If you are a patient who is told you only have six months to live and there are no options, but then all of a sudden you are given a more than 30% chance of survival with admittedly complex surgery, you would think that is a good option.”

Patients with liver tumors considered ‘unresectable' by standard liver resection should be considered for resection with an aggressive approach to liver surgery, concluded the authors. Significant advances over the past decade in the field of liver surgery allow surgeons today to perform potentially curative resections more safely for a greater number of patients, and with better long-term survival; according to the study, five-year survival of approximately one-third of patients can be expected.


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