Resection of the Falciform Ligament and Ligamentum Teres Hepatis in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)Thejus Thayyil Jayakrishnan1, Avishkar Sharma1, Anthony J Zacharias1, Paul M Knechtges2, Sam George Pappas3, Fabian M Johnston1, T Clark Gamblin1 and Kiran K Turaga1*
- *Corresponding Author:
- Kiran K Turaga, MD, MPH
9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
E-mail: [email protected]
Received Date: September 01, 2014; Accepted Date: September 23, 2014; Published Date: September 30, 2014
Citation: Jayakrishnan TT, Sharma A, Zacharias AJ, Knechtges PM, Pappas SG. Resection of the Falciform Ligament and Ligamentum Teres Hepatis in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Journal of Surgery [Jurnalul de chirurgie] 2014; 10(2):117-120 doi: 10.7438/1584-9341-10-2-5
Copyright: © 2014 Naidu K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Routine resection of falciform ligament and ligamentum teres hepatis (FL-LTH) during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) has been advocated but may be associated with increased complications. We aimed to study the role of FL-LTH resection at the time of CRS+HIPEC.
Methods: Retrospective review of patients who underwent CRS+HIPEC from January, 2010 to April, 2013 was conducted. Non-parametric methods were used for analyses.
Results: CRS-HIPEC was performed in 71 patients (FL-LTH resection in 57, 80.2%). The sensitivity and specificity of visual examination were calculated as 97.4% and 75.0%, respectively. Visual examination falsely classified 1/33 cases as disease free (3.0% False-negative, pathology showed carcinomatosis) and 6/24 as diseased (25% False-positive, pathology showed fibroadipose tissue). False-positive resection was not associated with increased complications (0/6). The recurrence in porta-hepatis (of n=48 with CC0 cytoreduction) was lower in the resected group (3/41, 7.3%) vs. nonresected (2/7, 28.6%), and associated with a hazard-ratio of 0.17 (95% CI 0.02 – 1.20, p-value 0.07) at a median 11 (IQR 7.0 – 16.7) months follow-up.
Conclusions: Visual examination during CRS+HIPEC may miss disease at the falciform ligament. A policy of routine resection is not associated with increased complications and should be considered.