Central hepatectomy for centrally located malignant liver tumors: A systematic review

Abstract

Aim: To study whether central hepatectomy (CH) can achieve similar overall patient survival and disease-free survival rates as conventional major hepatectomies or not.

Methods: A systematic literature search was performed in MEDLINE for articles published from January 1983 to June 2013 to evaluate the evidence for and against CH in the management of central hepatic malignancies and to compare the perioperative variables and outcomes of CH to lobar/extended hemihepatectomy.

Results: A total of 895 patients were included from 21 relevant studies. Most of these patients who underwent CH were a sub-cohort of larger liver resection studies. Only 4 studies directly compared Central vs hemi-/extended hepatectomies. The range of operative time for CH was reported to be 115 to 627 min and Pringle's maneuver was used for vascular control in the majority of studies. The mean intraoperative blood loss during CH ranged from 380 to 2450 mL. The reported morbidity rates ranged from 5.1% to 61.1%, the most common surgical complication was bile leakage and the most common cause of mortality was liver failure. Mortality ranged from 0.0% to 7.1% with an overall mortality of 2.3% following CH. The 1-year overall survival (OS) for patients underwent CH for hepatocellular carcinoma ranged from 67% to 94%; with the 3-year and 5-year OS having a reported range of 44% to 66.8%, and 31.7% to 66.8% respectively.

Conclusion: Based on current literature, CH is a promising option for anatomical parenchymal-preserving procedure in patients with centrally located liver malignancies; it appears to be safe and comparable in both perioperative, early and long term outcomes when compared to patients undergoing hemi-/extended hepatectomy. More prospective studies are awaited to further define its role.

Keywords: Central bisegmentectomy; Central hepatectomy; Mesohepatectomy; Middle hepatic lobectomy; Segment orientated liver resection.

Figure 1

Central hepatectomy-segment orientated resection. Couinaud segments are labeled 2-8; Caudate lobe (Segment 1) is not labelled in this diagram. here) Area shaded blue are the Central segments of 4, 5, 8 which are the segments resected in central hepatectomy (CH). Red rings indicate where the vascular outflow is encountered and ligated during CH.

Figure 2

Identification and screening of articles according to preferred reporting items for systematic reviews and meta-analyses recommendations.