Visceral organ resections combined with synchronous major hepatectomy: Examples of safety and feasibility

Background: Major hepatectomies are rarely combined with other extensive visceral resections, and data on feasibility and clinical outcome remain sparse. Methods: All patients undergoing simultaneous hepatic and visceral resection by a single surgeon in a tertiary care cancer center setting during 1999 and 2000 were analysed for indications, operative treatment and postoperative outcome. Results: Seven women were identified, with a median age of 50 years (range 42-83 years). Visceral resections were performed for colorectal cancer (n = 5), pancreatic islet cell tumor (n = 1) and gastric carcinoid (n = 1). The procedures included hemicolectomy (n = 3), sigmoidectomy (n = 1), pancreatoduodenectomy (n = 1), partial gastrectomy (n = 1) and pulmonary lobectomy (n = 1). The amount of liver tissue resected simultaneously ranged from 2 to >5 segments (median = 4). All operations led to an R0 resection. The median blood loss was 700 ml (500-2000 ml); median red blood cell transfusion requirement was 2 units (0-3 units). There was no post-operative death or complication, and the median hospital stay was 9 days (8-12 days). Six patients are alive 10-32 months postoperatively (median = 14.5 months). One patient who did not receive postoperative systemic therapy died of diffuse recurrence after 17 months. Two other patients experienced recurrent disease after 6 and 9 months, respectively; the remaining four individuals are free of disease. Conclusions: Major hepatic resections can be safely accompanied by other visceral resections in highly selected patients. Clinical and experimental parameters for this selection primarily involve patient co-morbidity, oncological failure and long-term survival considerations, loss of resectability in case of disease progression, incisional access, potential for hepatic regeneration, expertise to perform each procedure safely, availability of adjuvant treatment options and patient consent. Based on the experience presented, a highly individualised and selective approach to simultaneous resections can be recommended.