One Thousand Fifty-Six Hepatectomies Without Mortality in 8 Years

Abstract

Background: Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies. Hypothesis: By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero. Design: Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years. Setting: Tertiary referral center. Patients: 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. Main Outcome Measures: Operative mortality and morbidity rates.

Ultrasound-guided liver resection: Early experience in a district general hospital

“…In our study mortality rate was zero despite the limited number of patients, and major complications occurred in one patient only. Although numerous studies report a transfusion rate of packed red blood cells below 10% [9,10] or 30% [7,24], in our study 45% of the patients were transfused with packed red blood cells. However, all transfusions were carried out intraoperatively, but study criteria were followed only in one case.…”

“…US control during the execution of the resection cut permits confirmation or modification of the trajectory in real time, thus making it possible to resort to resection strategies which would otherwise be too difficult or too risky [4,21]. Some authors report an elevated number of cases in which the advanced application of US-guided liver resection decisively contributes to achieving zero postoperative mortality and a major complications rate below 9% [9,10]. In our study mortality rate was zero despite the limited number of patients, and major complications occurred in one patient only.…”

“…Bile leakage was defined as continuous drainage fluid with a bilirubin concentration greater than 5 mg/dl for more than 7 days or when intra-abdominal collection bilirubin level was greater than 5.0 mg/dl after puncture [10]. Hepatic failure was defined as a serum bilirubin concentration greater than 5.0 mg/dl, a prothrombin time rate below 50% for 3 or more consecutive days, or both [10]. Postoperative mortality was defined as death within 1 month of operation or during the hospital stay.…”

“…For these reasons IOUS with color Doppler has been used to guide hepatic surgery in liver cancer since the late 1970s [6]. The feasibility and effectiveness of this surgical approach have reduced resection-related mortality to values below 4% [7,8] and in some cases even to zero [9,10] as shown by numerous cases reported by high-volume liver centers over the last 5 years.…”

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

“…[4][5][6] The risk of mortality increases 5-fold in patients with prior ischemic heart disease undergoing non-cardiac surgery. 7 While advancements in surgery and anesthesia have lead to a dramatic improvement in post-hepatectomy mortality from 20% to nearly 0% over the last 3 decades, [8][9][10] the morbidity associated with complex liver resections remains considerable. In an Italian study evaluating 1500 consecutive patients undergoing hepatectomy, the authors observed a morbidity of 22.5%.…”