Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepatectomy is a standard hepatic surgical technique. The safety of hepatectomy has been improved in line with improvements in surgical techniques. This study analyzed the operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas (41.7%) and hepatolithiasis (29.6%) were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality (2.53%) was associated with extensive liver resections for hilar cholangiocarcinomas (two deaths in 79 cases). Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality.</p><p><b>CONCLUSIONS</b>Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.</p>

Liver resection: single center experiences of 2008 consecutive resections in 20 years / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%.</p><p><b>CONCLUSION</b>Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>