Liver resections for metastasis: surgical outcomes of a single center academic institution

Phillipe Abreu,Flávio Daniel Saavedra Tomasich,Vighnesh Vetrivel Venkatasamy,Luiz Arnaldo Szutan,Eduardo Dacás,Danilo Saavedra Bussyguin,Raphaella Ferreira

doi:10.1186/s12893-020-00920-7

Abstract

BackgroundHepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications.MethodsThis retrospective comparative descriptive study aims to evaluate a series of 86 consecutive liver resections (LRs) performed for the treatment of metastatic liver tumors, comparing the results between patients undergoing major and minor LR. All patients submitted to LR from October 2010 to July 2015 at the Erasto Gaertner Hospital in Curitiba-PR were included. Quantitative numerical variables were analyzed with the Student t-test. The nonparametric Mann–Whitney U test was used for numerical variables of non-normal distribution. Categorical variables were analyzed with the Chi-square test with Fisher's correction. The data were analyzed with the SPSS 23.0 and STATA 15 programs, being p < 0.05 considered statistically significant.ResultsEighty-six LR were performed, 56 cases by colorectal metastasis. The major LR corresponded to 68 cases, with 13.2% of Clavien-Dindo III–V complications and 2.9% of reoperation rate. Eighteen minor LR were performed and one patient had a postoperative complication requiring reoperation.ConclusionPreoperative elevation of transaminases and jaundice negatively influence surgical outcomes in patients undergoing LR. Tumors greater than 3 cm presented worse postoperative survival. Major LR did not significantly increase the surgical morbidity rate.Institutional Review Board registration1.122.319/2015

Highlights

Hepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications
Liver metastasis diagnosed at the same time or up to 6 months after the diagnose of the primary tumor were considered as synchronic metastases
The surgical outcomes of Liver resection (LR) are described in other studies, such as Resende et al which showed a rate of postoperative complications of 11.4%, including

Summary

Introduction

Hepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications. Secondary hepatic tumors are frequent because the liver is the main solid organ affected by hematogenic metastases [1]. There is a progressive trend in the indication of surgical approaches in hepatic metastases, due to the advance in tumor response to chemotherapy treatment, allowing the resection of tumors that initially exceeded the limits of resectability [4]. Patients with non-cirrhotic livers can tolerate a resection of up to 75% of its volume or up to 6 segments, but patients with Child–Pugh B or C livers have high rates of complications even when undergoing minor LRs [9]. The preoperative evaluation should be individualized according to the particularities of each case [8]

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Discussion

Conclusion