Anatomical Versus Atypical Liver Resections - Advantages and Disadvantages

Background: Liver resections (LR) are a daily practice rather than exception with the aim of radicalism (sometimes `radicalism` is the excuse and justification of the surgeon). From a different point of view, an aggressive approach may predispose to specific post-resection complications (SPRC). There still are debates about the most proper procedure - anatomical versus atypical LRs. Aim: The aim of this article is an analysis of the structure and rate of SPRC (acute liver failure=ALF, biliary leakage, bleeding) with a focus on a possible correlation to the surgical technique. Materials and Methods: 344 liver resections in total were performed at the authors` institution from January 1, 2007 to December 31, 2015. All the procedures were indicated by benign tumors as well as by primary and metastatic malignancies. The study design was single-center, retrospective and randomized. Inclusion criteria were the following: (1) Age ≤ 70 years; (2) Presence of ≤ 3 cormobid conditions; (3) Major LR, i.e. removal of ≥ 2 segments or ≥ 30% of liver parenchyma; (4) No synchronous (Н1) liver metastases or metachronous metastases + local recurrence necessitating a single-stage multivisceral resections. We collected all the data from the medical records. Finally, 102 cases were selected according to the above-formulated criteria and they were divided into 2 groups: (A) Anatomical LR (AnatLR) - 44 patients; (B) Atypical LR (AtypLR) - 58 patients. The incidence rate and other characteristics of SPRC were analyzed and a possible correlation between SPRC and the group affiliation was investigated. Results: The early mortality and SPRC rates were 2.8% (3 cases) and 19.4% (21 complications in 20 patients), respectively. Fatal outcome was caused by ALF after right hepatectomy (2 cases) and sepsis leading to MODS and MOF (1 case). Four patients (3.7%) received reoperation due to biliary leakage and/or bleeding from the resection surface. The remaining 17 SPRCs were overcome by conservative treatment. There was no statistically significant difference in mortality and morbidity rates in group A and group B. Conclusions: A successful outcome after a major LR depends on many factors: preserved preoperatively liver function, definitive bilio- and hemostasis on the resection surface, as minimal as possible blood loss and prevention of postoperative biliary hypertension. In our study, we found that an AnatLR is an aggressive and risky procedure for acute liver failure, while a precise AtypLR may guarantee also a low rate of SPCR. The advantages and disadvantages of both techniques must be researched based on late results in oncologic cases