Surgery News - February 2008 - (Page 18)

18 TRANSPLANT SURGERY NEWS • F E B R U A RY 2 0 0 8 Redefining Standard Resection Liver • from page 1 1-94 months, he said at the annual meeting of the Southern Surgical Association. A tumor was considered unresectable by standard resection if the extent of the tumor was too great or the disease could not be managed without resection of the inferior vena cava, hepatic veins, or any biliohepatic vasculature. Although there might be some bias in the investigators’ determination of resectability because they may never see many of the truly unresectable patients, through the use of current modalities and therapies, he said. Of 830 adult patients who underwent liver resection at the University of Florida during 1997-2007, Dr. Hemming and his coinvestigators focused on 116 who initially had been categorized as unresectable by standard resection at an outside institution that was known to perform more than 15 liver resections per year. These patients had a median age of 50 years (range of 18-74 years) and had follow-up lasting the point of the study is that “we’re not seeing many patients that are [categorized as] resectable,” Dr. Hemming explained. He added that the study shows there are patients who are being called unresectable before they have undergone adequate imaging that should occur in the decisionmaking process to determine resectability. Evaluations for resection probably occurred in 5-10 times more patients than in the 830 who actually underwent resection during this time period, he said. The patients had underlying diagnoses of intrahepatic cholangiocarcinoma (34), hilar cholangiocarcinoma (26), colorectal cancer metastases (25), hepatocellular carcinoma American College of Surgeons 94th annual Clinical Congress (20), gallbladder cancer metastasis (8), metastatic sarcoma (1), ocular melanoma metastasis (1), and colorectal cancer with direct extension into the pancreas, duodenum, and liver (1). Of the 116 patients, 18 (16%) had unresectable liver disease due to intraperitoneal implants (7), unreconstructable hepatic vein involvement (5), unreconstructable hepatic artery involvement (4), or disease in the planned liver remnant that was unresectable or “unablatable” (2). Preoperative portal vein embolization was necessary in 47 patients. Resections in the 116 patients involved: 78 trisectionectomies 18 lobectomies 1 mesohepatectomy in conjunction with pancreatic resection 1 segment V and VI resection combined with pancreatoduodenectomy, nephrectomy, and colectomy 14 pancreatic resections in addition to liver resections 4 right lobectomies performed as staged procedures. Unresectable patients had no operative mortality and stayed in the hospital a median of 5 days. Of the 98 resected patients, 3 died as a result of multiorgan failure after initial pneumonia, 2 from liver failure, Save the Date! The bile duct and inferior vena cava are resected in this right hepatectomy. Join us in San Francisco for the 94th annual Clinical Congress. As always, it will be an educational opportunity you won’t want to miss! Please be sure to visit www.facs.org in the coming months for more details regarding the educational program, registration, housing, and transportation. and 1 from pulmonary hemorrhage after severe aspiration pneumonia. Morbidity occurred in 35% of resected patients. These mortality and morbidity rates are similar to those in patients undergoing standard extended hepatectomy during the same period, Dr. Hemming said. The overall survival at 5 years was 32%, which is about the same as that of 5-10 years ago in patients who underwent standard resection for colorectal cancer metastases, he added. The median hospital length of stay for resected patients was 11 days, and surgical margins were clear of disease in 91 patients (93%). Some of the resections required reconstruction of the inferior vena cava (35), hepatic vein (21), portal vein (34), or hepatic artery (5). Resections were ultimately successful in 11 of 12 patients in whom resections previously had failed. Hypothermic infusions were used in 12 patients. “The primary caveat, though, is that this approach is not for everyone—not all patients or all surgeons. This requires a multidisciplinary approach: very complex decision making, partnering with experienced nonsurgical team members, and technical expertise and experience that are not available at all institutions. This approach likely should be limited to places that have the resources and experience to permit successful treatment,” said Dr. Reid B. Adams, an ACS Fellow with the University of Virginia, Charlottesville, who was a discussant at the meeting. ■ COURTERSY DR. ALAN W. HEMMING October 12–16, 2008: San Francisco, CA Moscone Convention Center http://www.facs.org http://www.facs.org

Table of Contents Feed for the Digital Edition of Surgery News - February 2008

Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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