Surgical outcomes of complex liver resection: Synchronous resection of other abdominal organs for locally advanced or metastatic disease

Electronic Poster Abstracts during elective cholecystectomy. Most cysts were located centrally. Before referral three cysts were treated with percutaneous aspiration or drainage and two were treated with operative deroofing. Four patients had liver resections by enucleation of cysts, two patients had deroofing and four had a formal liver resection. One patient needed a biliaryenteric reconstruction for an involved left duct. Mean operative time was 201 minutes. No invasive carcinoma was found on histology. There was no operative mortality with one liver abscess presenting one month post-operative. Two patients presented with recurrences, both after 24 months. Conclusion: Biliary cystadenomas are complex problems and should be the primary diagnostic consideration in middle aged women who have well encapsulated multilocular cystic liver tumours. Surgical resection offers optimal treatment.

EP01C-090 SURGICAL OUTCOMES OF COMPLEX LIVER RESECTION: SYNCHRONOUS RESECTION OF OTHER ABDOMINAL ORGANS FOR LOCALLY ADVANCED OR METASTATIC DISEASE D. Daly, R. Gandy and K. S. Haghighi HPB & Transplant Surgery, University Of New South Wales, Australia Introduction: Simultaneous resection of primary colorectal carcinoma and synchronous hepatic metastases confers increased morbidity. En bloc resection of hepatic tumours with adjacent viscera is believed to incur significant surgical risk. The aim of this study is to assess whether liver resection combined with resection of other abdominal organs can be performed without additional morbidity and mortality. Methods: A prospectively maintained database of all hepatic resections performed by a single surgeon (KH) between Jan 2007 and May 2015 was evaluated. Perioperative outcomes were evaluated for patients undergoing combined resection (CR) of liver and at least one other abdominal viscera, and compared to patients undergoing liver resection (LR) alone. Statistical analysis was performed using Fisher’s exact test and Mann-Whitney U test. Results: 68 patients underwent CR, while 432 patients underwent LR alone. The most common CR included pancreas (16), colon (16), small bowel (15), and diaphragm (12). 19 patients underwent multivisceral resection. En bloc CR was performed to achieve clear tumour margins in 22 patients. 31 patients underwent CR with major liver resection, and 19 received neo-adjuvant chemotherapy. Length of hospital admission was greater in CR (median 10 days versus LR 7 days). Peri-operative complications occurred in 19.1% (CR) versus 15.0% (LR). 90-day mortality was 1.5% (CR) versus 1.9% (LR). Conclusion: Liver resection can be combined with resection of other abdominal viscera with acceptably low rates of morbidity and mortality. Our results support the safety of potentially curative complex liver resection for selected patients with locally advanced or multivisceral metastatic disease.

HPB 2016, 18 (S1), e1ee384

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Table Patient demographics and perioperative outcomes

Combined Liver Resection Resection Alone (LR) (CR)

Statistical Significance (p-value)

Number

68

432

N/A

Mean Age (years)

58.2

59.3

0.38

Major Liver Resection

31 (45.6%) 241 (55.8%) 0.12

Mean Operative Time (minutes)

163

155

0.62

Mean Operative Blood Loss (millilitres)

322

354

0.81

Length of ICU Admission (median days)

1

1

0.11

7

<0.01

Length of Hospital 10 Admission (median days) Perioperative Complications

13 (19.1%) 65 (15.0%)

0.39

90-day Mortality

1 (1.5%)

0.83

8 (1.9%)

EP01C-091 THE VALIDATION ON PREDICTION OF LIVER DAMAGE WITH THE LEVEL OF LIVER ENZYME COMPARING WITH CT AFTER HEPATECTOMY USING PROPENSITY SCORE IN PERIOPERATIVE PERIOD K. H. Kwon1, C. I. Yoon2, J. Y. Choi3, J. H. Lim2, S. H. Kim4 and K. S. Kim5 1 Surgery, National Health Insurance Corporation Ilsan Hospital, 2Surgery, 3Radiology, Yonsei University College of Medicine, 4Surgery, Yonsei University Wonju College of Medicine, and 5Yonsei University College of Medicine, Republic of Korea Advances in the field of hepatic surgery and perioperative care have substantially improved surgical outcomes. Ischemia and reperfusion (IR) injury after hepatectomy is associated with poor hepatic microperfusion. In clinical practice, IR injury is defined by postoperative liver enzymes levels. The aim of study was to define that the amount of change inliver enzyme predicted the degree of liver damage. From January 2008 through April 2012, 124 patients were underwent hepatic resection for benign and malignant disease by single surgeon. The clinical and laboratory data were collected and CT scans at POD 5 day were retrospectively reviewed. The patients with or without liver damage were matched by using Propensity Score. After the matching, we compared these 22 Damage group patients with matched 66 No-Damage group patients with respect to short-term liver enzyme results. There were no difference in hematologic laboratory parameters between liver damage and no-damage group. AST in liver damage group was higher than in no-damage group at POD 1 and 3 but the ALT at POD 1, 3, 5 and 7. The difference