Results and Risk Factors in Hepatic Resection 506 cases

ABSTRACT

BACKGROUND: With advances in the techniques of liver resection as well as with better improvement of preoperative and postoperative care, hepatic resections for liver disease have become more common. This study presents a review of our experience for hepatic resection and an analysis of potential risk factors affecting the morbidity and the mortality in a hepatectomy. METHOD: From 1970 to 1996, 506 patients underwent hepatic resections; 139 patients with benign hepatic diseases, 329 patients with primary hepatic malignancy, and 38 patients with secondary hepatic malignancy. RESULTS: We divided the patients into two groups. Group 1 had 272 patients (from 1970 to 1990), and group 2 had 234 patients (from 1991 to 1996). As compared with group 1, group 2 had more malignant diseases than non-malignant diseases as operative indications. In the patients resected for primary hepatic malignancy, the 1-, 2-, 3-, and 5-year survival rates were 56.6%, 36.7%, 30.1%, and 15.2%, respectively, and 1-, 2-, 3-, 4-, and 5-year survival rates for a hepatocellular carcinoma were 58.5%, 41%%, 30.1%, 25.3%, and 17.2% and for a cholangiocarcinoma 39.5%, 22.5%, 19%, 8.3%, and 5.2%, respectively. The overall operative mortality rate was 5.9% (30/506), 7.4% in group 1 and 4.3% in group 2. The significant risk factors for perioperative mortality were liver cirrhosis, jaundice, increase of postoperative alkaline phosphatase, extended time needed for operation (above 4 hours), massive transfusion during operation (above 5,000 cc), malnutrition and/or weight loss (above 10%), low hemoglobin (below 10 gm%) and low serum albumin level (below 3.0 gm). Also, the major complicationsinfluencing perioperative mortality were liver failure, perioperative hemorrhage, cholangitis, intraabdominal abscess, sepsis, pulmonary lesions, and renal failure. CONCLUSION: After 1990, minor resections having enough margin from the hepatic malignant lesion have increased. However there has been no difference in the survival rate compared with that for a major resection for hepatic malignant diseases. Rather, operative morbidity, perioperative mortality, and postoperative complications have decreased in favor of a minor resection for hepatic malignant diseases.