{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T17:02:12Z","timestamp":1785603732596,"version":"3.56.0"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In select clinical scenarios, advanced techniques for volume manipulation and vascular reconstruction are needed for complete hepatic tumor removal. These highly complex liver resections (HCLRs) entail a heightened risk of severe complications. Here, we describe the results of HCLR performed in a 3\u2010year time period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We conducted a retrospective analysis encompassing patients who underwent hepatic resections between June 15, 2020, and June 15, 2023. HCLR was defined according to previously established criteria, and included associating liver partition and portal vein ligation for staged hepatectomy.\u00a0The outcomes of HCLR were compared to all non\u2010HCLR performed within the same time frame.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 167 hepatic resections, 26 were considered HCLR, and all were major resections. Five utilized total vascular exclusion, with venovenous bypass\u00a0in three, and hypothermic liver perfusion in three. Five resections included vascular reconstructions, and one included hypothermic circulatory arrest for extraction of a tumor extending to the right atrium. Of the non\u2010HCLR, 38 (26.9%) were major, and 49 (34.7%) were performed laparoscopically. The rates of overall major postoperative complications were comparable between those who underwent HCLR versus non\u2010HCLR. HCLR was associated with increased rates of biliary complications, readmissions, and reoperation. However, no postoperative 90\u2010day mortality was documented within patients that underwent HCLR compared to two in the non\u2010HCLR group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In expert hands, HCLR can be performed with acceptable complication profile, akin to that of major non\u2010HCLR. Those with questionable resectability should be referred to tertiary hepato\u2013pancreato\u2013biliary centers.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27573","type":"journal-article","created":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T08:00:11Z","timestamp":1704182411000},"page":"901-910","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Highly complex liver resections: Exploring the boundaries of feasibility and safety"],"prefix":"10.1002","volume":"129","author":[{"given":"Niv","family":"Pencovich","sequence":"first","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Pery","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rony","family":"Eshkenazy","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ido","family":"Nachmany","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2011.00330.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2016.03.039"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.09.017"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-015-5058-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-018-4020-6"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000152017.62778.2f"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000787"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.10.001"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl19233"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-14182-z"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3431-3"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.27573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T06:08:42Z","timestamp":1711692522000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.27573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/jso.27573"],"URL":"https:\/\/doi.org\/10.1002\/jso.27573","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-12-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}