One Thousand Fifty-Six Hepatectomies Without Mortality in 8 Years

TLDR

Operative mortality after liver resection remains above 2 % in most recent studies despite advances in diagnosis and surgery. The study hypothesizes that improved pre‑ and postoperative care and surgical expertise can reduce liver resection mortality to zero. A retrospective cohort of 1 056 consecutive hepatectomies performed on 915 patients at a single tertiary referral center over eight years was analyzed for morbidity and mortality. None of the 1 056 hepatectomies resulted in operative death, while major complications occurred in 3 % of hepatocellular carcinoma cases, 8 % of other liver malignancies, 28 % of biliary malignancies, and 5 % of living donor transplants, with operative blood loss ≥ 1 000 mL, bilirubin ≥ 1.0 mg/dL, and operative time > 6 h identified as independent risk factors for certain groups.

Abstract

<h3>Background</h3> Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. <h3>Hypothesis</h3> By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. <h3>Design</h3> Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. <h3>Setting</h3> Tertiary referral center. <h3>Patients</h3> A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases. <h3>Main Outcome Measures</h3> Operative mortality and morbidity rates. <h3>Results</h3> No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (≥17 µmol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study. <h3>Conclusions</h3> Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.