Perioperative Risk Factors of the Hepatic Resection

ABSTRACT

This study was conducted to investigate the risk factors for postoperative mortality and morbidity in 322 consecutive hepatic resections. The indications for the hepatic resection were 178 intrahepatic stones, 81 hepatocellular carcinomas, 21 cholangiocarcinomas, 16 benign liver tumors, 12 metastatic liver cancers, 7 liver abscesses, and 7 other diseases. The overall in-hospital mortality and morbidity rates were 0.9% and 39.4%, respectively. Various postoperative complications developed, including 60 wound infections (18.6%), 49 pulmonary complications (15.2%), 19 bile leakages (5.9%), 13 intraabdominal abscesses (4.0%), 13 ascites (4.0%), 4 bleedings (1.2%), 3 hepatic failures (0.9%), 3 cholangitis (0.9%) and 28 other complications (8.7%). Among the risk factors, perioperative transfusion was significantly associated with more frequent wound infections (p=0.004), pulmonary complications(p=0.008), and bile leakages (p=0.039). Coexisting hepatitis was related to increased pulmonary complication rate (p=0.0223) and ascites formation (p=0.0157). Diabetes, was associated with increased wound infection rate (p=0.0433), and preexisting heart disease was associated with higher pulmonary complication rate (p= 0.0213). However, age, presence of liver cirrhosis, extent of resection, operative time, pulmonary disease or combined bowel surgery had no influence on the outcome. In conclusion, minimizing perioperative blood loss and transfusion is essential to reduce postoperative complications in hepatectomy.