The team from New York, USA, assessed the nature of changes in the field of hepatic resectional surgery and the impact of these changes on perioperative outcome.
The researchers examined data from 1803 consecutive patients undergoing hepatic resection at the Memorial Sloan-Kettering Cancer Center, New York, from 1991 to 2001.
Demographics, extent of resection, concomitant major procedures, operative and transfusion data, complications, and hospital stay were analyzed.
Factors associated with morbidity and mortality, and trends in operative and perioperative variables over the study period were also assessed.
The team found that malignant disease was the most common diagnosis (91%), with metastatic colorectal cancer accounting for 62% of these cases.
Also that, 375 resections (21%) were performed for primary hepatic or biliary cancers and 161 (9%) for benign disease.
Anatomical resections were performed in 1568 patients (87%), these included 544 extended hepatectomies, 483 hepatectomies, and 526 segmental resections.
|Decrease in operative mortality from 4% to 1%.|
|Annals of Surgery|
The team found that 62% of patients had three or more segments resected, 42% had bilobar resections, and 37% had concomitant additional major procedures.
It was discovered that the median blood loss was 600 ml and 49% of patients were transfused at any time during the index admission.
Median hospital stay was 8 days, morbidity was 45%, and operative mortality was 3.1%.
The research team identified a significant increase in the use of parenchymal-sparing segmental resections, as well as a decrease in the number of hepatic segments resected, during the study period.
In parallel with this, there was a significant decline in blood loss, the use of blood products, and hospital stay.
Furthermore, despite an increase in concomitant major procedures, operative mortality decreased from 4% in the first 5 years of the study, to 1% in the last 2 years. There were no operative deaths in the last 184 consecutive cases.
By using multivariate analysis, the team revealed that the number of hepatic segments resected and operative blood loss were the only independent predictors of both perioperative morbidity and mortality.
Dr William Jarnagin's team concluded that, "Over the past decade, the use of parenchymal-sparing segmental resections has increased significantly".
And that, "The number of hepatic segments resected and operative blood loss were the only predictors of both perioperative morbidity and mortality.
"Reductions in these are largely responsible for the decrease in perioperative mortality, which has occurred despite an increase in concomitant major procedures".