Systematic Review
Copyright ©2014 Baishideng Publishing Group Inc.
World J Hepatol. May 27, 2014; 6(5): 347-357
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.347
Table 1 Characteristics and results of studies on central hepatectomy (1983-2013) n (%)
Ref.YearnDiagnosisOperative time (min)Vascular controlBlood loss (mL)MorbidityMortalitySurvival outcome
Hasegawa et al[27]198916HCC, CRM300-660Pedicle occlusion600-75007 (50)1 (6)Median OS 34 mo
Makuuchi et al[28]199317HCC, CCA, CRM412NA14827 (41.1)1 (5.8)NA
Nagino et al[29]199815Hilar CCANANANANANANA
Wu et al[17]199915HCC474Pringle’s maneuver or pedicle occlusion24503 (20)0 (0)1-yr OS 67%1-yr DFS 53%
3-yr OS 44%3-yr DFS 31%
6-yr OS 30%5-yr DFS 21%
Scudamore et al[19]200018HCC, CRM, GBC238Pringle’s maneuver91411 (61.1)0 (0)NANA
Yamashita et al[30]200116HCC, CCA, metastases, hemangioma, othersNANANANANANANA
3Jarnagin et al[3]200215Benign and malignant lesionsNANANANANANANA
Wu et al[22]200258HCC, CCA, metastases409Total hepatic flow clamping (28 patients)16858 (8.5)0 (0)NANA
399Selective clamping of ipsilateral blood flow (30 patients)115910 (33.3)0 (0)NANA
Hu et al[23]200352HCC265NA10309 (17)0 (0)Median OS 51 moMedian DFS 23 mo
Chouillard et al[25]200319HCC, metastases, CCA, benign tumor280Pringle’s maneuver ± hepatic vein clampingNANA0 (0)NANA
1Chen et al[18]2006118HCC128Pringle’s maneuver ± IVC occlusion59236 (30.5)1 (0.8)NANA
Kim et al[31]200635HCC, CCA, hepatic sarcoma331Extraglissonian approach and parenchymal Kelly crushing5162 (5.7)1 (2.8)1-yr OS 94%NA
2-yr OS 72%
5-yr OS 62%
Giuliante et al[32]200718HCC, metastases448Intermittent pedicle clampingNA6 (33.3)0 (0)NANA
1Chen et al[33]2007246HCC177 (with preoperative TACE)Pringle’s maneuver ± IVC control79031 (34.8)3 (3.4)1-yr OS 87.1%1-yr DFS 75%
3-yr OS 62.9%3-yr DFS 46.2%
5-yr OS 46.2%5-yr DFS 31.8%
115 (without)42038 (24.2)1 (0.6)1-yr OS 82.2%1-yr DFS 69.6%
3-yr OS 54.4%3-yr DFS 38%
5-yr OS 31.7%5-yr DFS 16.5%
1Chen et al[7]2008256HCC174Pringle’s maneuver ± IVC control750 (Pringle only); 380 (Pringle with IVC control)72 (28.1)1 (0.4)1-yr OS 77.0%1-yr DFS 59.1%
3-yr OS 49.8%3-yr DFS 28.8%
5-yr OS 35.1%5-yr DFS 17.0%
Mehrabi et al[34]200848HCC, metastases, CCA, GBC, hemangioma, other238Pringle’s maneuver in 9 patients112013 (27.1)1 (2)NA3-yr DFS 47.9%
Lee et al[20]200827HCC330Pedicle ligation140012 (44.4)2 (7.9)NANA
Arkadopoulos et al[35]201236HCC, metastases180Selective hepatic vascular exclusion/Pringle’s maneuver (16 patients)6506 (37.5)0 (0)NANA
150Sequential hemihepatic vascular control (20 patients)4009 (45)0 (0)NANA
Gallagher et al[36]201321HCC627Intermittent Pringle’s maneuver15904 (19)1 (4.8)1-yr OS 90.5%1-yr DFS 65%
3-yr OS 66.8%3-yr DFS 34.8%
5-yr OS 66.8%5-yr DFS 34.8%
Cheng et al[8]201263HCC230Pringle’s maneuver5008 (12.7)5 (7.9)1-yr OS 87.5%1-yr DFS 50%
5-yr OS 53.1%5-yr DFS 15%
3Yang et al[37]2013150HCCNAPringle maneuverNANANANA
Total number8952range115-627380-2450Overall morbidity: 27.5%Overall mortality: 2.3%
(range: 12.7%-61.1%)(range: 0%-7.1 %)
Table 2 Summary of case-control studies comparing central hepatectomies and lobar/extended hepatectomies n (%)
Ref.YearResection typenOperative time (min)Blood loss (mL)MortalityMorbidityComplications (n)
Wu et al[17]1999Central hepatectomy1547424500 (0)3 (20)Bile leak (1), pleural effusion (1), ascites (1)
Extended hepatectomy2534818631 (4)6 (24)Bile Leak (2), pleural effusion (1), ascites (1), prolonged jaundice (2), intra-abdominal abscess (2), wound infection (1)
P value0.090.230.430.99-
Scudamore et al[19]2000Central hepatectomy182389140 (0)1intra (5.5)Intraoperative bleeding (1), pneumonia (2), intra-abdominal fluid collection (2), fever longer than 48 hours (2), transient fever (2), bile leak (1), late intra-abdominal fluid collection (1)
Lobar hepatectomy7122210251 (1.4)9early (50)NA
1late (5.6)
6intra (8.5)
29early (40.8)
3late (4.2)
Extended hepatectomy4330416280 (0)2intra (4.7)NA
21early (48.9)
9late (20.9)
P value< 0.0010.009 for extended vs central-0.05 for late complications-
Hu et al[23]2003Central hepatectomy52265NA0 (0)9 (17)Bile leak (3), pleural effusion (3), 1 postoperative massive ascites (1), subphrenic abscess (1)
Conventional or extended hepatectomy63264NA2 (3.1)12 (19)Bile leak (2), wound infection (4), pneumonia (2), liver failure (2), subphrenic abscess (1), pleural effusion (1)
P value0.9530.4080.491-
Cheng et al[8]2012Central hepatectomy632305005 (7.9)8 (12.7)Liver failure (2), bile leak (1)1
Hemi-/extended hepatectomies413167503 (7.3)6 (14.6)Liver failure (2), bile leak (1)
P value< 0.0010.0041.0000.777-
TotalCentral hepatectomy148Mean 268Mean 8823.4% (0%-7.9%)20.90% (range: 20%-66.7%)
Hemi-/extended hepatectomies243Mean 299Mean 13522.9% (0%-7.3%)38.70% (range: 14.6%-74.4% )
Table 3 Type and frequency of complications reported following central hepatectomy
Type of complication1Number reported (n = 200)Frequency (%)
Surgical complications
Bile leakage/biloma3618
Intra-abdominal abscess168
Wound infection73.5
Intestinal perforation10.5
Medical complications
Pleural effusion/empyema6231
Pneumonia/pulmonary infection136.5
Pulmonary edema63
Upper gastrointestinal bleeding31.5
Urinary tract infection31.5
Transient hepatic dysfunction/ prolonged jaundice31.5
Hepatic necrosis/liver failure31.5
Acute renal failure21
Deep vein thrombosis10.5
Other (not specified)42