Perioperative management of primary liver cancer

AIM： TO minimize the complications and mortality and improve the survival in primary liver cancer （PLC） patients undergoing hepatic resection. METHODS： We conducted a retrospective analysis of 2143 PLC patients treated from January 1990 to January 2004. The patients were divided into two groups usin...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2007-04, Vol.13 (13), p.1970-1974
Main Authors: Yan, Lu-Nan, Chen, Xiao-Li, Li, Zhi-Hui, Li, Bo, Lu, Shi-Chun, Wen, Tian-Fu, Zeng, Yong, Yiao, Hui-Hua, Yang, Jia-Yin, Wang, Wen-Tao, Xu, Ming-Qing
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular - physiopathology
Carcinoma, Hepatocellular - surgery
Child
Cholangiocarcinoma - physiopathology
Cholangiocarcinoma - surgery
Energy Metabolism - physiology
Female
Humans
Ketone Bodies - blood
Liver - metabolism
Liver - physiopathology
Liver - surgery
Liver Neoplasms - blood
Liver Neoplasms - physiopathology
Liver Neoplasms - surgery
Male
Middle Aged
Perioperative Care - methods
Predictive Value of Tests
Rapid Communication
Retrospective Studies
Survival Rate
Treatment Outcome
原发性肝癌
围手术期
肝切除术
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Summary:AIM： TO minimize the complications and mortality and improve the survival in primary liver cancer （PLC） patients undergoing hepatic resection. METHODS： We conducted a retrospective analysis of 2143 PLC patients treated from January 1990 to January 2004. The patients were divided into two groups using January 1997 as a cut-off. Small tumor size （〈 5 cm）, preoperative redox tolerance index （RTI）, vascular control method, and postoperative arterial ketone body ratio （AKBR） were used as indicators of surgical outcome. RESULTS： Small tumors had less complications and lower mortality and higher overall survival rate. Use of RTI for selecting patients and types of hepatectomy, reduced complications （21.1% vs 11.0%） and mortality （1.6% vs 0.3%）. The half liver vascular occlusion protocol （n = 523） versus the Pringle method （n = 476） showed that the former significantly reduced the postoperative complications （25.8% vs 11.9%） and mortality （2.3% vs 0.6%） respectively, and cut mean hospital stay was 3.5 d. Postoperative AKBR was a reliable indicator of the energy status in survivors. CONCLUSION： RTI is of value in predicting hepatic functional reserve, half liver occlusion could protect the residual liver function, and AKBR measurement is a simple and accurate means of assessing the state of postoperative metabolism. Optimal perioperative management is an important factor for minimizing complications and mortality in patients undergoing hepatic resection.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v13.i13.1970