Journal of Surgery

Resection of the Falciform Ligament and Ligamentum Teres Hepatis in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Abstract

Thejus Thayyil Jayakrishnan, Avishkar Sharma, Anthony J Zacharias, Paul M Knechtges, Sam George Pappas, Fabian M Johnston, T Clark Gamblin and Kiran K Turaga

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.