Varianty rezektsii pecheni pri zlokachestvennykh opukholyakh

Abstract

The paper analyzes the results of surgical treatment in 85 patients with malignant liver tumors. According to the nature of a tumor process, all the patients were divided into two group: 1) 16 (18.8%) patients with hepatocellular carcinoma (HCC) and 2) 69 (81.9%) with colorectal cancer liver metastases (CCLM). The staging distribution of patients was as follows: 1) (TNM) 7 (43.7%) patients with Stages II-III and 9 (56.3%) with Stage IVA; 2) mTNM) 1 (1.4%) patient with Stage I, 12 (17.4%) with Stage II, 15 (21.7%) with Stage III, and 31 (44.9%) with Stage IVA, and 10 (14.5%) with Stage IVB. Choice of a resection mode was determined by the clinical and pathological factors of a tumor and the functional reserve of the liver. Extended hemihepatectomy (EHH) was carried out in 6 patients with HCC; hemihepatectomy (HH) in 2; bisegmentectomy in 2, and segmentectomy in 1; nonanatomic resections in 4; a combination of anatomic and non-anatomic resections in 1. Fifty-three (77%) and 7 (10%) patients with CCLM underwent anatomic and anatomic resections, respectively; a combination of both resection modes was performed in 9 (13%0 cases. According to the volume of anatomic resection, the patient distribution was as follows: EHH in 15 (28%) patients, HH in 21 (40%), bisegmentectomy in 7 (15%), and segmentectomy in 10 (19%). The preoperative risk for hepatic failure was assessed by ultrasonography and a methacetin breath test. No extensive resection was made if the hepatectomy index was less 3.8%. Postoperative complications occurred in 4 patients with HCC. Post-CCLM mortality was 4.3%. In patients with HCC, 5-year survival was 48%; in those with CCLM, 5-year overall and relapse-free survival were 35.1 and 22.4%, respectively.

Keywords

type of operation / disease stage / methacetin breath test / survival

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