HEPATIC RESECTIONS FOR PRIMARY LIVER-CANCER

The medical records of 399 patients who underwent hepatic resection be tween January 1981 and December 1990 were reviewed. Information regard ing the results of the hepatic resection in terms of the operative ind ication, operative procedure, operative morbidity, and mortality was a bstracted. As of the end of 1990, a total of 402 hepatic resections ha d been completed, including those of 319 primary malignancies, 4 secon dary malignancies, 2 gallbladder carcinomas, 42 cases of intrahepatic cholelithiasis, and 35 benign masses. Major hepatic resections were pe rformed on 117 patients (29%), of whom 60 (51%) had histologically pro ven liver cirrhosis. Minor hepatic resections were performed on the re maining 285 patients (71%). Sepsis was the most frequent complication, which manifested primarily as wound infection (71 cases) or intraabdo minal infection (25 cases). Nonfatal hepatic failure occurred in nine patients with cirrhosis and one patient without cirrhosis. There were 38 operative deaths among the 402 hepatic resections, for an overall o perative mortality of 9.4%; 25 of those deaths were due to hepatic fai lure after the operation, accounting for 66% of the total operative mo rtality. There was an increasing frequency of hepatic resection during the last 5 years. The indication for resection due to hepatocellular carcinoma increased from 87 to 195 cases. The cumulative data show a d ecrease in the incidence of complications and the operative mortality rate. In the most recent period, nonlethal postoperative complications occurred in 135 of 286 patients (47%). The overall 1-, 3-, and 5-year survival rates for 172 patients, excluding cases of operative mortali ty, palliative resection, and re-resection, were 71.0%, 39.8%, and 28. 3%, respectively.