OPERATIVE RISK OF MAJOR HEPATECTOMY - A S ERIES OF 113 CONSECUTIVE EXTENSIVE HEPATECTOMIES

Up to now, liver resections have been the initial treatment of almost all cancers and benign tumors limited to a liver lobe. This retrospect ive review assesses the results of a consecutive series of 113 major e lective hepatic resections during a ten-year period. Major hepatectomy was defined by the resection of at least 3 Couinaud segments. Mean ag e was 52 years (20 to 79 years). There were 62 women and 51 men. 35 re sections were performed for colorectal metastases, 22 for a benign tum or, 20 for non-colorectal metastases, 11 for hydatid disease, 10 for h epatocarcinoma, 7 for cholangiocarcinoma and 8 for other indications. The resections performed were 86 right hepatectomies with 18 extended right hepatectomies, 24 left hepatectomies with 4 extended left hepate ctomies and 3 trisegmentectomies. Total vascular exclusion was used in 22 patients (19%). Mortality rare was zero. Significant morbidity was encountered in 24 patients (21%). These results suggest that the mort ality rate may be independent of the extent of liver resection, provid ed that hepatic function is normal and preoperative selection adequate . With improving surgical management and techniques, and the use of in tra-operative sonography, extensive liver surgery can now be performed with a very low mortality rate.