A comparison of right posterior sectorectomy with formal right hepatectomy: A dual-institution study

Sarah B. Fisher, Peter J. Kneuertz, Rebecca M. Dodson, Sameer H. Patel, Shishir K. Maithel, Juan M. Sarmiento, Maria C. Russell, Kenneth Cardona, Michael A. Choti, Charles A. Staley, Timothy M. Pawlik, David A. Kooby

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives Right posterior sectorectomy (RPS) preserves liver volume but typically requires a longer parenchymal transection distance than does right hepatectomy (RH). This study was conducted to define the advantages of one approach over the other. Methods Databases at two institutions were retrospectively reviewed for all patients submitted to RPS or RH between January 2000 and August 2012. Primary outcomes were perioperative complications and 90-day mortality. Results Patients undergoing RPS (n = 100) and RH (n = 480), respectively, were similar in demographics, comorbidities, operative indications and Model for End-stage Liver Disease (MELD) mean scores (7.8 in the RPS group and 7.7 in the RH group; P = 0.49). A comparison of the RPS group with the RH group showed no significant differences in mean estimated blood loss (697 ml versus 713 ml; P = 0.900), rate of transfusions (19.2% versus 17.1%; P = 0.720), margin-positive resection (9.2% versus 11.6%; P = 0.70), complications (41.8% versus 42.0%; P = 1.000), bile leak (3.0% versus 4.0%; P = 1.000), or length of stay (7.5 days versus 8.3 days; P = 0.360). Postoperative hepatic insufficiency (defined as a postoperative bilirubin level of >7 mg/dl or significant ascites), occurred less frequently after RPS (1.0% versus 8.5%; P = 0.005). Operation type remained an independent determinant of postoperative hepatic insufficiency after controlling for preoperative risk factors (RH: hazard ratio = 9.628, 95% confidence interval 1.295-71.573; P = 0.027). A total of 28 (4.8%) patients died within 90 days; these included 25 (5.2%) patients in the RH group and three (3.0%) in the RPS group (P = 0.449). Conclusions Despite similar blood loss and overall morbidity, RPS is associated with less hepatic insufficiency than RH. Right posterior sectorectomy is parenchyma-sparing and should be strongly considered when it is technically feasible and oncologically sound.

Original languageEnglish (US)
Pages (from-to)753-762
Number of pages10
JournalHPB
Volume15
Issue number10
DOIs
StatePublished - Oct 2013

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Hepatectomy
Hepatic Insufficiency
Patient Rights
End Stage Liver Disease
Bilirubin
Ascites
Bile
Comorbidity
Length of Stay
Demography
Databases
Confidence Intervals
Morbidity
Mortality
Liver

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Fisher, S. B., Kneuertz, P. J., Dodson, R. M., Patel, S. H., Maithel, S. K., Sarmiento, J. M., ... Kooby, D. A. (2013). A comparison of right posterior sectorectomy with formal right hepatectomy: A dual-institution study. HPB, 15(10), 753-762. https://doi.org/10.1111/hpb.12126

A comparison of right posterior sectorectomy with formal right hepatectomy : A dual-institution study. / Fisher, Sarah B.; Kneuertz, Peter J.; Dodson, Rebecca M.; Patel, Sameer H.; Maithel, Shishir K.; Sarmiento, Juan M.; Russell, Maria C.; Cardona, Kenneth; Choti, Michael A.; Staley, Charles A.; Pawlik, Timothy M.; Kooby, David A.

In: HPB, Vol. 15, No. 10, 10.2013, p. 753-762.

Research output: Contribution to journalArticle

Fisher, SB, Kneuertz, PJ, Dodson, RM, Patel, SH, Maithel, SK, Sarmiento, JM, Russell, MC, Cardona, K, Choti, MA, Staley, CA, Pawlik, TM & Kooby, DA 2013, 'A comparison of right posterior sectorectomy with formal right hepatectomy: A dual-institution study', HPB, vol. 15, no. 10, pp. 753-762. https://doi.org/10.1111/hpb.12126
Fisher SB, Kneuertz PJ, Dodson RM, Patel SH, Maithel SK, Sarmiento JM et al. A comparison of right posterior sectorectomy with formal right hepatectomy: A dual-institution study. HPB. 2013 Oct;15(10):753-762. https://doi.org/10.1111/hpb.12126
Fisher, Sarah B. ; Kneuertz, Peter J. ; Dodson, Rebecca M. ; Patel, Sameer H. ; Maithel, Shishir K. ; Sarmiento, Juan M. ; Russell, Maria C. ; Cardona, Kenneth ; Choti, Michael A. ; Staley, Charles A. ; Pawlik, Timothy M. ; Kooby, David A. / A comparison of right posterior sectorectomy with formal right hepatectomy : A dual-institution study. In: HPB. 2013 ; Vol. 15, No. 10. pp. 753-762.
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abstract = "Objectives Right posterior sectorectomy (RPS) preserves liver volume but typically requires a longer parenchymal transection distance than does right hepatectomy (RH). This study was conducted to define the advantages of one approach over the other. Methods Databases at two institutions were retrospectively reviewed for all patients submitted to RPS or RH between January 2000 and August 2012. Primary outcomes were perioperative complications and 90-day mortality. Results Patients undergoing RPS (n = 100) and RH (n = 480), respectively, were similar in demographics, comorbidities, operative indications and Model for End-stage Liver Disease (MELD) mean scores (7.8 in the RPS group and 7.7 in the RH group; P = 0.49). A comparison of the RPS group with the RH group showed no significant differences in mean estimated blood loss (697 ml versus 713 ml; P = 0.900), rate of transfusions (19.2{\%} versus 17.1{\%}; P = 0.720), margin-positive resection (9.2{\%} versus 11.6{\%}; P = 0.70), complications (41.8{\%} versus 42.0{\%}; P = 1.000), bile leak (3.0{\%} versus 4.0{\%}; P = 1.000), or length of stay (7.5 days versus 8.3 days; P = 0.360). Postoperative hepatic insufficiency (defined as a postoperative bilirubin level of >7 mg/dl or significant ascites), occurred less frequently after RPS (1.0{\%} versus 8.5{\%}; P = 0.005). Operation type remained an independent determinant of postoperative hepatic insufficiency after controlling for preoperative risk factors (RH: hazard ratio = 9.628, 95{\%} confidence interval 1.295-71.573; P = 0.027). A total of 28 (4.8{\%}) patients died within 90 days; these included 25 (5.2{\%}) patients in the RH group and three (3.0{\%}) in the RPS group (P = 0.449). Conclusions Despite similar blood loss and overall morbidity, RPS is associated with less hepatic insufficiency than RH. Right posterior sectorectomy is parenchyma-sparing and should be strongly considered when it is technically feasible and oncologically sound.",
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T1 - A comparison of right posterior sectorectomy with formal right hepatectomy

T2 - A dual-institution study

AU - Fisher, Sarah B.

AU - Kneuertz, Peter J.

AU - Dodson, Rebecca M.

AU - Patel, Sameer H.

AU - Maithel, Shishir K.

AU - Sarmiento, Juan M.

AU - Russell, Maria C.

AU - Cardona, Kenneth

AU - Choti, Michael A.

AU - Staley, Charles A.

AU - Pawlik, Timothy M.

AU - Kooby, David A.

PY - 2013/10

Y1 - 2013/10

N2 - Objectives Right posterior sectorectomy (RPS) preserves liver volume but typically requires a longer parenchymal transection distance than does right hepatectomy (RH). This study was conducted to define the advantages of one approach over the other. Methods Databases at two institutions were retrospectively reviewed for all patients submitted to RPS or RH between January 2000 and August 2012. Primary outcomes were perioperative complications and 90-day mortality. Results Patients undergoing RPS (n = 100) and RH (n = 480), respectively, were similar in demographics, comorbidities, operative indications and Model for End-stage Liver Disease (MELD) mean scores (7.8 in the RPS group and 7.7 in the RH group; P = 0.49). A comparison of the RPS group with the RH group showed no significant differences in mean estimated blood loss (697 ml versus 713 ml; P = 0.900), rate of transfusions (19.2% versus 17.1%; P = 0.720), margin-positive resection (9.2% versus 11.6%; P = 0.70), complications (41.8% versus 42.0%; P = 1.000), bile leak (3.0% versus 4.0%; P = 1.000), or length of stay (7.5 days versus 8.3 days; P = 0.360). Postoperative hepatic insufficiency (defined as a postoperative bilirubin level of >7 mg/dl or significant ascites), occurred less frequently after RPS (1.0% versus 8.5%; P = 0.005). Operation type remained an independent determinant of postoperative hepatic insufficiency after controlling for preoperative risk factors (RH: hazard ratio = 9.628, 95% confidence interval 1.295-71.573; P = 0.027). A total of 28 (4.8%) patients died within 90 days; these included 25 (5.2%) patients in the RH group and three (3.0%) in the RPS group (P = 0.449). Conclusions Despite similar blood loss and overall morbidity, RPS is associated with less hepatic insufficiency than RH. Right posterior sectorectomy is parenchyma-sparing and should be strongly considered when it is technically feasible and oncologically sound.

AB - Objectives Right posterior sectorectomy (RPS) preserves liver volume but typically requires a longer parenchymal transection distance than does right hepatectomy (RH). This study was conducted to define the advantages of one approach over the other. Methods Databases at two institutions were retrospectively reviewed for all patients submitted to RPS or RH between January 2000 and August 2012. Primary outcomes were perioperative complications and 90-day mortality. Results Patients undergoing RPS (n = 100) and RH (n = 480), respectively, were similar in demographics, comorbidities, operative indications and Model for End-stage Liver Disease (MELD) mean scores (7.8 in the RPS group and 7.7 in the RH group; P = 0.49). A comparison of the RPS group with the RH group showed no significant differences in mean estimated blood loss (697 ml versus 713 ml; P = 0.900), rate of transfusions (19.2% versus 17.1%; P = 0.720), margin-positive resection (9.2% versus 11.6%; P = 0.70), complications (41.8% versus 42.0%; P = 1.000), bile leak (3.0% versus 4.0%; P = 1.000), or length of stay (7.5 days versus 8.3 days; P = 0.360). Postoperative hepatic insufficiency (defined as a postoperative bilirubin level of >7 mg/dl or significant ascites), occurred less frequently after RPS (1.0% versus 8.5%; P = 0.005). Operation type remained an independent determinant of postoperative hepatic insufficiency after controlling for preoperative risk factors (RH: hazard ratio = 9.628, 95% confidence interval 1.295-71.573; P = 0.027). A total of 28 (4.8%) patients died within 90 days; these included 25 (5.2%) patients in the RH group and three (3.0%) in the RPS group (P = 0.449). Conclusions Despite similar blood loss and overall morbidity, RPS is associated with less hepatic insufficiency than RH. Right posterior sectorectomy is parenchyma-sparing and should be strongly considered when it is technically feasible and oncologically sound.

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