Prevention of Liver Failure in Extended Hepatic Resection
Background. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.Materials and methods. A retrospec...
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Bashkir State Medical University
2021-04-01
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| Series: | Креативная хирургия и онкология |
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| Online Access: | https://www.surgonco.ru/jour/article/view/563 |
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| author | G. Kh. Mirasova I. Z. Salimgareev M. O. Loginov A. I. Gritsaenko M. A. Nartaylakov |
| author_facet | G. Kh. Mirasova I. Z. Salimgareev M. O. Loginov A. I. Gritsaenko M. A. Nartaylakov |
| author_sort | G. Kh. Mirasova |
| collection | DOAJ |
| description | Background. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.Materials and methods. A retrospective analysis of 228 various-extent liver resections included minor (55.7 %), major (26.8 %) and extended (17.5 %) operations for malignant, benign and parasitic liver lesions. The post-resection liver failure rate has ben graded according to ISGLS.Results and discussion. Postoperative hepatic failure developed in 58 (25.4 %) cases, including 5 of 127 minor (3.9 %) resections, 18 major (29.5 %) and 35 of 40 extended resections (87.5 %). Mild class A liver failures were reported in 12.3 %, and severe classes B and C — in 9.2 % and 3.9 % cases, respectively.CT volumetry in place of the number of resected segments is suggested as a criterion to grade the expected post-resection residual liver, with >70 % defining a minor, 36–70 % — major and 25–35 % — extended expected residual liver.A two-staged extended hepatic resection approach is proposed to reduce postoperative liver failure, with vascular radiology-guided right portal vein embolisation (RPVE) or associating liver partition and portal vein ligation (ALPPS) at stage 1.A comparison of extended hepatic resection outcomes (n = 40) showed a significantly higher rate and severity of liver failure in single- vs. two-staged operations (p < 0.05).Conclusion. Liver failure is a leading cause of death in major and extended hepatic resection. Preoperative CT volumetry allows a more accurate volumetric control of expected post-resection residual liver. Two-staged extended hepatic resection can reliably reduce the rate and severity of postoperative liver failure. |
| format | Article |
| id | doaj-art-89a90f358a314f2e9aed2117c4d32e70 |
| institution | DOAJ |
| issn | 2076-3093 2307-0501 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | Bashkir State Medical University |
| record_format | Article |
| series | Креативная хирургия и онкология |
| spelling | doaj-art-89a90f358a314f2e9aed2117c4d32e702025-08-20T03:19:20ZengBashkir State Medical UniversityКреативная хирургия и онкология2076-30932307-05012021-04-01111101410.24060/2076-3093-2021-11-1-10-14410Prevention of Liver Failure in Extended Hepatic ResectionG. Kh. Mirasova0I. Z. Salimgareev1M. O. Loginov2A. I. Gritsaenko3M. A. Nartaylakov4G.G. Kuvatov Republican Clinical HospitalG.G. Kuvatov Republican Clinical HospitalG.G. Kuvatov Republican Clinical HospitalBashkir State Medical UniversityBashkir State Medical University; G.G. Kuvatov Republican Clinical HospitalBackground. Postoperative failure is a major cause of adverse outcomes in extensive liver resection. Post-resection liver failure requires intensive, including extracorporeal, care. Issues in correcting liver failure warrant novel approaches to prevent severe cases.Materials and methods. A retrospective analysis of 228 various-extent liver resections included minor (55.7 %), major (26.8 %) and extended (17.5 %) operations for malignant, benign and parasitic liver lesions. The post-resection liver failure rate has ben graded according to ISGLS.Results and discussion. Postoperative hepatic failure developed in 58 (25.4 %) cases, including 5 of 127 minor (3.9 %) resections, 18 major (29.5 %) and 35 of 40 extended resections (87.5 %). Mild class A liver failures were reported in 12.3 %, and severe classes B and C — in 9.2 % and 3.9 % cases, respectively.CT volumetry in place of the number of resected segments is suggested as a criterion to grade the expected post-resection residual liver, with >70 % defining a minor, 36–70 % — major and 25–35 % — extended expected residual liver.A two-staged extended hepatic resection approach is proposed to reduce postoperative liver failure, with vascular radiology-guided right portal vein embolisation (RPVE) or associating liver partition and portal vein ligation (ALPPS) at stage 1.A comparison of extended hepatic resection outcomes (n = 40) showed a significantly higher rate and severity of liver failure in single- vs. two-staged operations (p < 0.05).Conclusion. Liver failure is a leading cause of death in major and extended hepatic resection. Preoperative CT volumetry allows a more accurate volumetric control of expected post-resection residual liver. Two-staged extended hepatic resection can reliably reduce the rate and severity of postoperative liver failure.https://www.surgonco.ru/jour/article/view/563hepatic resectionliver failurepostoperative complicationsct volumetryliver volumehepatic encephalopathy |
| spellingShingle | G. Kh. Mirasova I. Z. Salimgareev M. O. Loginov A. I. Gritsaenko M. A. Nartaylakov Prevention of Liver Failure in Extended Hepatic Resection Креативная хирургия и онкология hepatic resection liver failure postoperative complications ct volumetry liver volume hepatic encephalopathy |
| title | Prevention of Liver Failure in Extended Hepatic Resection |
| title_full | Prevention of Liver Failure in Extended Hepatic Resection |
| title_fullStr | Prevention of Liver Failure in Extended Hepatic Resection |
| title_full_unstemmed | Prevention of Liver Failure in Extended Hepatic Resection |
| title_short | Prevention of Liver Failure in Extended Hepatic Resection |
| title_sort | prevention of liver failure in extended hepatic resection |
| topic | hepatic resection liver failure postoperative complications ct volumetry liver volume hepatic encephalopathy |
| url | https://www.surgonco.ru/jour/article/view/563 |
| work_keys_str_mv | AT gkhmirasova preventionofliverfailureinextendedhepaticresection AT izsalimgareev preventionofliverfailureinextendedhepaticresection AT mologinov preventionofliverfailureinextendedhepaticresection AT aigritsaenko preventionofliverfailureinextendedhepaticresection AT manartaylakov preventionofliverfailureinextendedhepaticresection |