13. Makuuchi, Semin Surg Oncol 1993
Ascites
None or controlled Not controlled
ICGR15 Limited resection Enucleation Not indicated for hepatectomy
Trisectorectomy
bisectorectomy
Left-sided
hepatectomy
Right-sided
sectoriectomy
Segmentectomy Limited resection Enucleation
Normal 1.1 – 1.5 mg/dL 1.6 – 1.9 mg/dL > 2.0 mg/dL
Total bilirubin level
Normal 10% - 19% 30% - 39% > 40%20% - 29%
Vert d’Indocyanine
14. Major impact of pre-operative platelet rate < 150.000 / mL
22%
6%
Liver Failure: 11%
Mortality : 9%
2011
Maithel, JACS 2011
15. Only hepatic venous pressure gradient > 10 mmHg was significant in
multivariate analysis for decompensated cirrhosis after hepatectomy
Risk factor in univariate analysis
Bilirubin rate
Urea rate
Rate of platelet
ICG Clearence
Hepatic venous pressure gradiant,
Décompensation de la cirrhose : Persistance d’une ascite à 3 mois Bruix, Gastro 1996
23. Truant, JACS 2007
• RLV-BWR was more relevant than RLV-TLV in predicting postoperative course after
right trisectionectomy
• Patients with an anticipated RLV < 0,5% of the body weight were at risk of hepatic
dysfunction
• No deaths in the group of patients with RLV/BWR >0,5%
26. Agrawal, HPB 2011
Pre-operative liver biopsy to detect NASH in order to:
• Limit the extent of hepatic resection
• Use the PVE to optimize the post-operative outcome
• Aggressively treat the cardiovascular associated
disease
27. Wakai, JGIS 2011
• 225 patients
• 3 groups NAFLD – HCV – HBV
• Morbidity 59% vs 31/28% p= 0,043
• Mortality 12% vs 0,7%/3,3% p= 0,016
42. Rubbia-Brandt, Ann Oncol 2004
• 51% of patients who received pre-operative
chemotherapy had sinusoidal dilatation
• 25% perisinusoidal and venocclusive fibrosis
• Developement correlated to the use of Oxaliplatine
50. De Graaf, J Nucl Med 2010
Cut-off 2,5%/min/m2 can predict the incidence of liver failure
3% vs 56%
51. Chimiothérapie - Conclusions
• Attention aux lésions induites par la chimiothérapie
(> 6 cycles)
• Augmentation de la morbidité post-opératoire
• Une augmentation des cycles n’augmente pas la
réponse pathologique
• Bevacizumab a un effet protecteur sur le
développent de SOS
54. Kawasaki, Ann Surg 2003
Morbidity related to biliary drainage 2,5%
No post-operative liver failure
55. Seyama, Ann Surg 2003
Cholangitis 30% (initial period)
1 Tumor seeding (percuteneous)
No post-operative liver failure
56. Grandadam, Ann Surg Oncol 2010
Mortality 10,5% in the group without optimization
57. Sugawara Surgery 2013
• 21% of cholangitis in patients with biliary
drainage
• 75% of positive bile cultures at the operation
• No difference in postoperative morbidity and
mortality in patients with and without biliary
drainage
59. Hirano, JHBP Sc 2014
P=0,004
• Tumor seeding on the of
percutaneous drainage
• Peritoneal recurrence in the
percutaneous group
• Better survival for endoscopic
drainage
63. Farges BJS 2013
• Biliary drainage does not affect mortality
• Decrease the mortality rate after right sided
hepatectomy
• Increase mortality after left sided
hepatectomy
• Preoperative bilirubine > 50 mmol increases
mortality
65. Cholestase - Conclusions
• Optimisation du patient avant chirurgie
• Drainage biliaire du foie restant par voie
endoscopique
• Traiter de façon systématique les patients avec
prothèses biliaires avec antibiotiques à large
spectre