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Parenchymal preservation reduces mortality after hepatectomy

Parenchymal preservation reduced mortality rate and complications in patients who underwent hepatectomy for malignancies, according to newly published data. 

“The majority of patients with metastatic colorectal cancer are never sent to a liver surgeon because of the impression that a liver operation is too dangerous and patient outcomes are poor,” T. Peter Kingham, MD, FACS, a surgeon at Memorial Sloan Kettering Cancer Center in New York City, said in a press release. “But we’ve shown that it’s possible to do safe liver resection, so patients should be considered for hepatic parenchymal preservation.”

T. Peter Kingham

Kingham and colleagues investigated whether a correlation exists between surgical methods, mortality and complication rates over 19 years. To do this, researchers analyzed data of all patients who underwent liver resection at Memorial Sloan Kettering Cancer Center between 1993 and 2012. According to the research, 3,875 patients underwent 4,152 resections for cancer, with the most common diagnosis being metastatic colorectal cancer (64%).

Over the course of the study period, the 90-day mortality rate decreased from 5% to 1.6%; perioperative morbidity decreased from 53% to 20%; the amount of major hepatectomies decreased from 66% to 36%; and perioperative transfusion rates decreased from 51% to 21% (P < .001 for all). The most common complication was abdominal infection, which occurred in 11.6% of all resections, according to the research. However, abdominal infection decreased from 16.5% to 8.6% over time.

Analyses showed peak postoperative bilirubin to be an independent predictor of perioperative morbidity (P < .001), as well as blood loss (P = .001) and major hepatectomy (P = .031).

“The biggest take away from our study is that parenchymal preservation should be applied to all patients undergoing liver operations for malignancies because the data show that the mortality rate and complication rate, the blood loss, the requirement for blood transfusions, time in the hospital, all of these things which we are all trying to improve on, are all less,” Kingham said in the release. “That is an important message because parenchymal preservation is not always done. … In the end, there is a real difference in a patient’s mortality risk: the more segments of liver that you take out, the higher the risk to the patient.”

Kingham added: “We hope our study findings interest more physicians who advise patients with liver cancers to send their patient to be evaluated by a liver surgeon, particularly high-risk patients who previously may not have been considered for a liver operation at all.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.