Prospective Study
Copyright ©The Author(s) 2016.
World J Hepatol. Aug 28, 2016; 8(24): 1038-1046
Published online Aug 28, 2016. doi: 10.4254/wjh.v8.i24.1038
Table 1 Patients’ characteristics shown as total and as subgroups according to the types of resection n (%)
Patient characteristicsTotalAnatomical resectionsAtypical resections > 5 cmCombination of ana-tomical and atypical resections > 5 cmP-values3
No. of liver resections175845437n.d.
No. of liver surgeries143775016n.d.
No. of surgeries with ≥ 2 similar resections14 (9.8)7 (9.1)4 (8.0)3 (18.8)n.d.
No. of surgeries with ≥ 1 additional wedge resection529 (20.3)10 (13.0)14 (28)5 (31.3)n.d.
No. of surgeries with ≥ 1 additional radiofrequency ablation25 (17.5)7 (9.1)11 (22)7 (43.8)n.d.
Demographics
Gender (female/male)174/6941/3624/269/70.48043
BMI (kg/m2)225.5 (17.4-53.2)24.8 (17.4-53.2)27.1 (18.1-36.0)25.2 (18.8-29.6)0.36604
Age (yr)260.0 (16-85)59.0 (16-85)61.5 (28-84)63.5 (22-78)0.49524
Preoperative ASA scores 1/2/3/418/77/58/03/42/32/02/28/20/03/7/6/00.42473
5/54/41/04/54/42/04/56/40.0/019/44/37/0
Indications for liver surgery< 0.00013
Malignant primary liver tumors23 (16.1)15 (19.5)8 (16.0)0
Liver metastases91 (63.6)44 (57.1)34 (68.0)13 (81.2)
Benign liver tumors19 (13.3)10 (13.0)6 (12.0)3 (18.8)
Others10 (7.0)8 (10.4)2 (4.0)0
Preoperative chemotherapy170 (49.0)33 (42.9)26 (52)11 (68.8)0.42813
Steatosis grade of normal liver20.91953
Steatosis 0%-9% (grade 0)103 (72.0)56 (72.7)37 (74.0)10 (62.5)
Steatosis 10%-29% (grade 1)26 (18.2)14 (18.2)8 (16.0)4 (25.0)
Steatosis ≥ 30% (grade 2)14 (9.8)7 (9.1)5 (10.0)2 (12.5)
Cirrhosis (Child-Pugh A)19 (6.3)5 (6.5)4 (8.0)00.85683
1Values are total number of patients (%);
2Continuous variables are expressed as median (range);
3P-values of categorical variables;
4Calculated by χ2 test and continous ones by One-way Anova analysis of variance. No significance between the group of anatomical, atypical, and combinated resections for selected variables was found, except for indications for surgery;
5Liver wedge resection is defined as obtaining a liver specimen with a maximum diameter of less than 5 cm. n.d.: Not determined; BMI: Body mass index.
Table 2 Extent of anatomical resections based on segmental and sectorial anatomy of the liver according to Brisbane classification
Type of anatomical liver resectionn
Extended right hemihepatectomy6
Extended left hemihepatectomy3
Right hemihepatectomy31
Left hemihepatectomy12
Right posterior sectorectomy4
Right anterior sectorectomy1
Left lateral sectionectomy19
Segmentectomy19
Bisegmentectomy24
Trisegmentectomy2
Total of anatomical liver resections121
Table 3 Perioperative parameters and characteristics of hepatic resections, shown as total and as subgroups according to the types of resection
Perioperative dataTotal (n = 143)Anatomical resections (n = 77)Atypical resections > 5 cm (n = 50)Combination of anatomical and atypical resections (n = 16)P-values
Intraoperative parameters
Median operation time (min)361 (78-726)386 (134-726)299 (78-692)362 (120-567)0.00613
Median CVPmin during liver resection (mmHg)4 (-5 to 14)3 (-5 to 12)  5 (-3 to 14)4 (-4 to 12)0.0511
Median total blood loss per procedure (n = 143) (mL)500 (50-5000)500 (50-5000)400 (50-1500)700 (150-2400)0.02143
No. of patients needing ECs (% of n = 143 procedures)122 (15%)14 (18%)6 (12%)2 (13%)0.9854
Mean number of ECU during total hospital stay, per procedure (n = 143)20.4 ± 0.10.5 ± 0.10.3 ± 0.10.2 ± 0.10.4844
Postoperative parameters
Median length of ICU stay (d)3 (0-44)3 (0-15)3 (0-44)3 (2-5)0.2960
Median length of hospital stay (d)13 (3-99)14 (3-95)12 (4-99)12 (7-32)0.04503
Maximum SAPS, median (range)27 (7-40)26 (14-40)27 (7-40)27 (14-39)0.6001
Median weight of resected liver tissue (g) per procedure (n = 143)340 (8-1850)525 (51-1850)53 (8-490)352 (40-1018)< 0.00013
1Since some patients had simultaneously more than 1 resection, the percentage of the perioperative need for ECs is calculated per number of procedures. P-values were calculated, comparing the variable of interest in between the different resection groups (Anova one-way analysis Kruskal-Wallis);
2Continuous variables are expressed as median (range), except presented as mean ± SEM;
3Denote statistical significance among resections in the group of anatomical, atypical, and combinated resections. CVP: Central venous pressure; EC: Erythrocyte concentrate; ECU: Erythrocyte concentrate unit; ICU: Intensive care unit; SAPS: Simplified acute physiology score.
Table 4 Perioperative alterations of laboratory parameters, shown as total and as subgroups according to the types of resection
Serum parametersTotal (n = 143)
Anatomical resections (n = 77)
Atypical resections > 5 cm (n = 50)
Combination of ana-tomical and atypical resections > 5 cm (n = 16)
P-values
Median Δ-values1 (ranges)Median Δ-values1 (ranges)Median Δ-values1 (ranges)Median Δ-values1 (ranges)
ASAT (U/L, norm < 41)304 (-486 to 9885)346 (-486 to 9885)285 (-137 to 2361)463 (-5 to 1270)0.1747
ALAT (U/L, norm < 41)299 (-356 to 3909)300 (-356 to 3909)245 (-250 to 2200)421 (-27 to 1093)0.2635
Bilirubin (μmol/L, norm < 20)7 (-130 to 234)9 (-130 to 234)4 (-36 to 152)7 (-0.1 to 33.4)0.4605
Ammonia (μmol/L, norm 12-48)393 (14 to 155)413 (14 to 155)393 (20 to 90)373 (25 to152)0.50264
Albumin (g/L, norm 35-50)-8 (-41 to 192)-8 (-19 to 12)-6 (-20 to 192)-8 (-18 to 1)0.2262
Hemoglobin (g/L, norm 130-180)-37 (-83 to 0)-35 (-83 to 0)-37 (-71 to -4)-39 (-68 to -22)0.4654
Prothrobine time: Quick (%, norm > 70)-27 (-108 to 62)-32 (-81 to -9)-22 (-53 to 13)-35 (-63 to -7)0.00052
1Medians and ranges of Δ-values are presented. Δ-values are calculated by the difference between preoperative value and the maximum postoperative value or postoperative nadir. P-values were calculated, comparing the Δ-value of each serum marker among the different resection groups (One-way Anova analysis of variance);
2Denote statistical significance among resections in the group of anatomical, atypical, and combinated resections;
3Variable is presented as median value and range of postoperative maximum, since no preoperative values were available;
4P-value was calculated, comparing postoperatively determined ammonia levels (maximum) among the different resection groups (One-way Anova analysis of variance). ASAT: Aspartate transaminase; ALAT: Alanine aminotransferase.
Table 5 Pre-, intra- and postoperative values of Indocyangreen-clearance testing were available in 45 liver surgeries and were presented as total as well as subgroups according to the type of liver resection
ICG data1Total (n = 45)Anatomical resections (n = 27)Atypical resections > 5 cm (n = 13)Combination of anatomical and atypical resections > 5 cm (n = 5)P-values
R15 (%, norm 0-10)
Preoperative3.6 (0.1 to 28.4)3.6 (0.1 to 28.4)3.6 (0.2 to 16.3)2.7 (0.8 to 15)0.4573
Intraop. after resection12.4 (0.5 to 69.8)17.3 (0.5 to 69.8)6.5 (0.9 to 15.3)22.4 (1.3 to 28.8)0.03023
Postoperative day 25.8 (0.2 to 26.7)7.8 (0.2 to 26.7)3.2 (0.7 to 13.4)7.6 (0.9 to 12.1)0.04203
R15 Δ21.8 (-8.4 to 14.1)4.2 (-8.4 to 14.1)-0.2 (-5.2 to 9.8)0.5 (-0.9 to 8.4)0.0693
PDR (%, norm 18-25)
Preoperative22.2 (8.4 to 48)21.4 (8.4 to 48)22.2 (12.1 to 40.1)24.1 (12.0 to 31.0)0.6772
Intraop. after resection14.4 (2.4 to 35.3)11.7 (2.4 to 35.3)18.2 (12.5 to 31.2)9.5 (8.3 to 26.0)0.00473
Postoperative day 219.0 (8.8 to 40.3)17.5 (8.8 to 40.3)22.5 (13.4 to 28.4)17.5 (14.1 to 31.3)0.5732
PDR Δ2  -1.4 (-15 to 37.1)-3.7 (-12.9 to 37.1)0.1 (-15 to 7.4)-2.2 (-24.6 to 4.7)0.5534
1Median values and range of data are presented. As sensitive indicator for liver function the retention rate after 15 min (R15) and the plasma disappearance rate (PDR) were evaluated;
2Δ values of R15 and PDR were determined by the difference of preoperative and postoperative day 2 values. P values were calculated, comparing the variable of interest in between the different resection group (one-way Anova analysis of variance);
3Denote statistical significance among resections in the group of anatomical, atypical, and combinated resections. ICG: Indocyanine green clearance.