Extended Hepatectomy in Patients With Hepatobiliary Malignancies With and Without Preoperative Portal Vein Embolization

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Abstract
EXTENDED HEPATECTOMY (resection of ≥5 hepatic segments) is increasingly used to achieve margin-negative resection of hepatobiliary malignancies. Prolonged survival has been reported after complete hepatic resection of colorectal metastases,1,2 hilar cholangiocarcinoma,3,4 and hepatocellular carcinoma.5-7 Although the surgical mortality rate has been minimized as a result of improved patient selection and safer technique, complications associated with postoperative hepatic insufficiency, such as cholestasis, bleeding, fluid retention, and impaired hepatic synthetic function, still contribute to an extended hospital stay and protracted recovery.8-11 In the process of preoperative selection for extended hepatectomy, a subset of patients may be excluded from consideration for potentially curative resection because of limitations associated with an anticipated small liver remnant.