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Article: Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis

TitleHospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis
Authors
Issue Date1995
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 1995, v. 130 n. 2, p. 198-203 How to Cite?
AbstractObjective: To define the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality. Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survey was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994. Setting: A tertiary referral center. Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected. Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy. Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was the cutoff level that could maximally separate the patients with cirrhosis with and without mortality. Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.
Persistent Identifierhttp://hdl.handle.net/10722/83286
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFan, STen_HK
dc.contributor.authorLai, ECSen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:39:13Z-
dc.date.available2010-09-06T08:39:13Z-
dc.date.issued1995en_HK
dc.identifier.citationArchives Of Surgery, 1995, v. 130 n. 2, p. 198-203en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/83286-
dc.description.abstractObjective: To define the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality. Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survey was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994. Setting: A tertiary referral center. Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected. Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy. Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was the cutoff level that could maximally separate the patients with cirrhosis with and without mortality. Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshBlood Loss, Surgical - statistics & numerical dataen_HK
dc.subject.meshCarcinoma, Hepatocellular - complications - surgeryen_HK
dc.subject.meshDiscriminant Analysisen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHepatectomy - adverse effects - contraindications - methods - mortalityen_HK
dc.subject.meshHepatitis, Chronic - complications - surgeryen_HK
dc.subject.meshHong Kong - epidemiologyen_HK
dc.subject.meshHospital Mortalityen_HK
dc.subject.meshHumansen_HK
dc.subject.meshIndocyanine Green - diagnostic useen_HK
dc.subject.meshIntraoperative Complications - epidemiologyen_HK
dc.subject.meshLiver Cirrhosis - complications - surgeryen_HK
dc.subject.meshLiver Neoplasms - complications - surgeryen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPatient Selectionen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshSafetyen_HK
dc.subject.meshSurvival Rateen_HK
dc.titleHospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosisen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=130&spage=198&epage=203&date=1995&atitle=Hospital+mortality+of+major+hepatectomy+for+hepatocellular+carcinoma+associated+with+cirrhosisen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid7848092-
dc.identifier.scopuseid_2-s2.0-0028794825en_HK
dc.identifier.hkuros10589en_HK
dc.identifier.hkuros3660-
dc.identifier.volume130en_HK
dc.identifier.issue2en_HK
dc.identifier.spage198en_HK
dc.identifier.epage203en_HK
dc.identifier.isiWOS:A1995QF29300016-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLai, ECS=36932159600en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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