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World J Gastroenterol. Apr 7, 2007; 13(13): 1970-1974
Published online Apr 7, 2007. doi: 10.3748/wjg.v13.i13.1970
Perioperative management of primary liver cancer
Lu-Nan Yan, Xiao-Li Chen, Zhi-Hui Li, Bo Li, Shi-Chun Lu, Tian-Fu Wen, Yong Zeng, Hui-Hua Yiao, Jia-Yin Yang, Wen-Tao Wang, Ming-Qing Xu
Lu-Nan Yan, Xiao-Li Chen, Zhi-Hui Li, Bo Li, Shi-Chun Lu, Tian-Fu Wen, Yong Zeng, Hui-Hua Yiao, Jia-Yin Yang, Wen-Tao Wang, Ming-Qing Xu, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Lu-Nan Yan, MD, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunan688@163.com
Telephone: +86-28-85422476 Fax: +86-28-85423724
Received: November 23, 2006
Revised: December 17, 2006
Accepted: March 12, 2007
Published online: April 7, 2007
Abstract

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.

Keywords: Liver cancer; Hepatectomy; Optimal perioperative management; Arterial ketone body ratio; Redox tolerance index