Mesohepatectomy for centrally located liver tumours

Abstract

Background Mesohepatectomy (MH) avoids unnecessary sacrifice of functional parenchyma compared with extended hepatectomy (EH). The aim of this study was to compare the results of MH with those of EH in the management of centrally located liver tumours (CLLTs). Methods All patients with CLLTs treated by liver resection between 2005 and 2011 were enrolled in this retrospective study. The decision to use MH or EH was made on an individual basis. Outcomes of the procedures were compared and a classification system for MH was devised consisting of four types, with type IV representing the most complex procedure. Results MH was performed in 292 patients and EH in 138. MH was associated with a longer duration of operation (P < 0·001), higher intraoperative transfusion rate (P < 0·001) and lower complication rates (P = 0·001) compared with EH. There were no significant differences in hepatic inflow occlusion rate (P = 0·075), blood loss (P = 0·241) and length of hospital stay (P = 0·804) between the two groups. Type IV lesions had the longest duration of operation, greatest blood loss, and highest intraoperative transfusion and morbidity rates (all P < 0·050). Conclusion MH is a feasible and safe alternative to EH in selected patients with CLLTs. The proposed classification system may be useful in guiding the surgical treatment of CLLTs. Appropriate in selected cases © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.